[Federal Register Volume 78, Number 186 (Wednesday, September 25, 2013)]
[Rules and Regulations]
[Pages 59101-59119]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2013-22874]
[[Page 59101]]
Vol. 78
Wednesday,
No. 186
September 25, 2013
Part II
Department of Labor
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Office of Workers' Compensation Programs
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20 CFR Parts 718 and 725
Regulations Implementing the Byrd Amendments to the Black Lung Benefits
Act: Determining Coal Miners' and Survivors' Entitlement to Benefits;
Final Rule
Federal Register / Vol. 78 , No. 186 / Wednesday, September 25, 2013
/ Rules and Regulations
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
20 CFR Parts 718 and 725
RIN 1240-AA04
Regulations Implementing the Byrd Amendments to the Black Lung
Benefits Act: Determining Coal Miners' and Survivors' Entitlement to
Benefits
AGENCY: Office of Workers' Compensation Programs, Labor.
ACTION: Final rule.
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SUMMARY: This final rule revises the Black Lung Benefits Act (BLBA or
Act) regulations to implement amendments made by the Patient Protection
and Affordable Care Act (ACA). The ACA amended the BLBA in two ways.
First, it revived a rebuttable presumption of total disability or death
due to pneumoconiosis for certain claims. Second, it reinstituted
automatic entitlement to benefits for certain eligible survivors of
coal miners whose lifetime benefit claims were awarded because they
were totally disabled due to pneumoconiosis. These regulations clarify
how the statutory presumption may be invoked and rebutted and the
application and scope of the survivor-entitlement provision. The rule
also eliminates several unnecessary or obsolete provisions.
DATES: This rule is effective October 25, 2013.
FOR FURTHER INFORMATION CONTACT: Steven Breeskin, Director, Division of
Coal Mine Workers' Compensation, Office of Workers' Compensation
Programs, U.S. Department of Labor, 200 Constitution Avenue NW., Suite
C-3520, Washington, DC 20210. Telephone: (202) 343-5904 (this is not a
toll-free number). TTY/TDD callers may dial toll-free 1-800-877-8339
for further information.
SUPPLEMENTARY INFORMATION:
I. Background of This Rulemaking
On March 30, 2012, the Department issued a Notice of Proposed
Rulemaking (NPRM) under the BLBA, 30 U.S.C. 901-944, proposing revised
rules to implement amendments to the BLBA made by the ACA, Public Law
111-148, 1556, 124 Stat. 119, 260 (2010), and inviting public comment.
77 FR 19456-19478 (Mar. 30, 2012). These amendments reinstated two BLBA
entitlement provisions--Section 411(c)(4), 30 U.S.C. 921(c)(4) (the
``15-year presumption'') and Section 422(l), 30 U.S.C. 932(l)
(survivors' automatic entitlement provision)--that had been repealed
with respect to claims filed on or after January 1, 1982. As a result
of these amendments, a miner or survivor who files his or her claim
after January 1, 2005 may now rely on the 15-year presumption in
establishing entitlement to benefits, provided that the claim was
pending on or after March 23, 2010 and the presumption's requirements
for invocation are met. In addition, survivors whose claims meet the
effective-date requirements are entitled to benefits if the miner was
awarded disability benefits on a lifetime claim, assuming that the
survivor meets the BLBA's other conditions of entitlement (such as
relationship and dependency). The Department recounted the history of
these provisions in the NPRM. 77 FR at 19456-58. The Department also
proposed revising or ceasing publication of several related rules that
are obsolete or unnecessary. The NPRM's comment period closed May 29,
2012.
II. Statutory Authority
Section 426(a) of the BLBA, 30 U.S.C. 936(a), authorizes the
Secretary of Labor to prescribe rules and regulations necessary for the
administration and enforcement of the Act.
III. Discussion of Significant Comments
The Department received approximately fifteen comments on the
proposed regulations. Most of these comments focus on only a few
substantive issues. The Department's response to the major comments is
set forth below in the Section-by-Section Explanation, along with an
explanation of any changes made to the proposed rules in response. Some
members of the public applauded the Department for eliminating outdated
or unnecessary provisions and streamlining the regulations where
possible. See generally Executive Order 13563, 76 FR 3821 (January 18,
2011) (instructing agencies to review ``rules that may be outmoded,
ineffective, insufficient, or excessively burdensome, and to modify,
streamline, expand, or repeal them.''). The public submitted no
negative comments on the revisions proposed to Sec. Sec. 718.1, 718.2,
718.3(a), 718.202(a)(3), 718.301, 718.303, 718.306, Part 718 Appendix
C, 725.1, 725.2, 725.101(a)(1) and (2), 725.201, and 725.418.
Accordingly, the Department is promulgating these regulations as
proposed with the technical change explained below.
The Department has made an additional technical change and replaced
the term ``shall'' throughout the regulatory sections revised by this
final rule. Executive Order 13563 states that regulations must be
``accessible, consistent, written in plain language, and easy to
understand.'' 76 FR 3821. See also E.O. 12866, 58 FR 51735 (Sept. 30,
1993) (``Each agency shall draft its regulations to be simple and easy
to understand, with the goal of minimizing the potential for
uncertainty and litigation arising from such uncertainty.''). To that
end, the Department has removed the imprecise term ``shall'' in those
sections it is amending and substituted ``must,'' ``must not,''
``will,'' or other situation-appropriate terms. See generally Federal
Plain Language Guidelines, http://www.plainlanguage.gov/howto/guidelines; Black's Law Dictionary 1499 (9th ed. 2009) (``shall'' can
be read either as permissive or mandatory).
Some of the Department's rules as proposed in the NPRM used the
term ``shall.'' The final version eliminates the term from these
proposed subsections: Sec. Sec. 718.2(c), 718.202(a)(3),
718.305(b)(1)(iii), 718.305(b)(4), 718.305(d)(3), Part 718 Appendix C,
725.1(g), 725.309(c), 725.309(c)(1), 725.418(a), 725.418(a)(3), and
725.418(d). The final rule also makes similar technical changes to the
following subsections: Sec. Sec. 725.2(c), 725.101(a)(4),
725.101(a)(32)(i) through (iv), 725.101(b), 725.309(a), 725.309(c)(2)
through (4), 725.309(d), 725.418(b)-(c). (All references are to
regulations as designated in the final rule.) Although not included in
the NPRM, the Department has revised these additional subsections to
eliminate the term ``shall'' from all subsections of each amended
regulation. No change in meaning is intended.
Section-by-Section Explanation
20 CFR 718.205 Death due to pneumoconiosis
(a) Section 718.205 sets forth the criteria for establishing that a
miner's death was due to pneumoconiosis. The Department proposed
revising Sec. 718.205 to: (1) Clarify that some survivors need not
prove the miner died due to pneumoconiosis to be entitled to benefits
given the ACA's revival of Section 422(l); (2) expand the criteria to
include the Section 411(c)(4) 15-year presumption of death due to
pneumoconiosis for claims governed by the ACA amendments; and (3)
eliminate outmoded provisions. 77 FR at 19459-60. In particular, the
Department proposed revising the ``traumatic injury'' provision in
Sec. 718.205(c)(4) and redesignating it as Sec. 718.205(b)(5).
Section 718.205(c)(4) currently precludes survivor entitlement where
the miner's death was caused by a
[[Page 59103]]
traumatic injury or a medical condition unrelated to pneumoconiosis
``unless the evidence establishes that pneumoconiosis was a
substantially contributing cause of death.'' 20 CFR 718.205(c)(4)
(2011). To implement the 15-year presumption and clarify that certain
survivors could establish this required causal connection by
presumption, the Department proposed revising this last clause to read
``unless the claimant establishes (by proof or presumption) that
pneumoconiosis was a substantially contributing cause of death.'' 77 FR
19460, 19475.
(b) One comment asks the Department to adopt a blanket rule that a
survivor is not entitled to benefits when the miner commits suicide.
This commenter argues that suicide should never be compensable, even
where the survivor establishes that the miner suffered from complicated
pneumoconiosis and invokes the Section 411(c)(3) irrebuttable
presumption of entitlement, 30 U.S.C. 921(c)(3). The comment states
that allowing compensation in these circumstances is at odds with other
Federal workers' compensation statutes (including the Longshore and
Harbor Workers' Compensation Act, 33 U.S.C. 901-950), most state
workers' compensation systems, and public policy. The comment points to
Benefits Review Board and Sixth Circuit case precedent holding that a
survivor cannot recover benefits when a miner commits suicide.
Another comment strongly objects to this commenter, stating that
survivors should not be deprived of benefits in those tragic cases
where the miner commits suicide. This comment notes that the survivors
have likely nursed the disabled miner as his physical condition
deteriorated and contends that coal mine operators should bear
responsibility for the pain and psychological problems pneumoconiosis
causes.
The final rule treats suicide like any other traumatic event that
ends a miner's life. There is no basis in the statute or legislative
history to draw a distinction for suicide. Since 1983, the regulations
have explicitly recognized that pneumoconiosis might be a substantially
contributing cause of a death even when the miner's death was
immediately caused by a traumatic injury. When the Department first
promulgated Sec. 718.205, the regulation contained no provision
addressing traumatic injury or a principal cause of death other than
pneumoconiosis. But the Department noted legislative history
demonstrating Congress' intent ``that traditional workers' compensation
principles such as those, for example, which permit a finding of
eligibility where the totally disabling condition was significantly
related to or aggravated by the occupational exposure be included
within such regulations.'' 45 FR 13678, 13690 (Feb. 29, 1980) citing S.
Rep. No. 209, 95th Cong., 1st Sess. 13-14 (1977). In 1983, the
Department extensively revised Sec. 718.205 to implement the 1981
Amendments to the BLBA, which restricted survivor eligibility by
eliminating automatic entitlement for claims filed after 1981 and
required all survivors to prove that the miner's death was due to
pneumoconiosis. See generally 77 FR at 19456-57 (outlining statutory
history). Based on the accompanying legislative history, the Department
added Sec. 718.205(c)(4) to clarify that a survivor could prove
entitlement by showing that pneumoconiosis substantially contributed to
the miner's death even when the principal cause of death was a
traumatic injury or a medical condition unrelated to pneumoconiosis. 48
FR 24272, 24277-78 (May 31, 1983). Once again the Department noted
Congress' desire to ``make the federal statute consistent with
traditional workers' compensation principles.'' 48 FR at 24278.
The majority of states allow workers' compensation death benefits
when an otherwise compensable injury caused an employee to ``become
dominated by a disturbance of the mind of such severity to override
normal rational judgment'' which resulted in the employee taking his or
her own life. 2 John L. Gelman, Modern Workers Compensation Sec. 115:5
(West 2013); Lex K. Larson, Larson's Workers Compensation Law
Sec. Sec. 38.01-38.05 (Matthew Bender, Rev. Ed. 2012); see also, e.g.,
Graver Tank & Mfg. Co. v. Indus. Comm'n, 399 P.2d 664, 668 (Ariz. 1965)
(``where the original work-connected injuries suffered by the employee
result in his becoming devoid of normal judgment and dominated by a
disturbance of mind directly caused by his injury and its consequences,
such as severe pain and despair, the self-inflicted injury'' may be
compensable); Advance Aluminum Co. v. Leslie, 869 SW.2d 39, 41 (Ky.
1994) (``[A]n employee's suicide is compensable if (1) the employee
sustained an injury which itself arose in the course of and resulted
from covered employment; (2) without that injury the employee would not
have developed a mental disorder of such a degree as to impair the
employee's normal and rational judgment; and (3) without that mental
disorder, the employee would not have committed suicide.''). Contrary
to the commenter's assertion, this standard--often called the ``chain
of causation test''--has also been applied in cases arising under the
Longshore and Harbor Workers' Compensation Act, a federal workers'
compensation statute. E.g., Kealoha v. Director, OWCP, 713 F.3d 521,
524-25 (9th Cir. 2013) (``Given the best-reasoned modern trend of case
law, we hold that a suicide or injuries from a suicide attempt are
compensable under the Longshore Act when there is a direct and unbroken
chain of causation between a compensable work-related injury and the
suicide attempt.''). The rule is also applied in states where suicide
or attempted suicide is still a criminal offense. See, e.g., Kahle v.
Plochman, Inc., 428 A.2d 913, 917 (N.J. 1981) (adopting the chain of
causation rule); Petty v. Associated Transp., Inc., 173 SE.2d 321, 329
(N.C. 1970) (same). Thus, contrary to the adverse comment, ``[i]n
effect, no jurisdictions recognize suicide as an intentional act that
automatically breaks the chain of causation to defeat a claim for death
benefits.'' Campbell v. Young Motor Co., 684 P.2d 1101, 1102 (Mont.
1984).
The commenter primarily relies on the Sixth Circuit's decision in
Johnson v. Peabody Coal Co., 26 F.3d 618 (6th Cir. 1994), to support
the view that a miner's suicide should always bar his survivors'
entitlement. Johnson considered Sec. 718.205(c)(4) in the suicide
context. The court found the Act's legislative history to be silent on
whether psychological injury may establish the causal link between
pneumoconiosis and death. In part because the then-applicable 1981
Amendments ``were designed to limit, not expand benefits,'' 26 F.3d at
620, the court concluded that benefits should not be paid to the
survivors of a miner who commits suicide. But that important reasoning
is no longer valid because the ACA amendments repealed many of the
restrictions on benefits that were instituted by the 1981 Amendments
and considered by the Johnson court. Accordingly, the Department does
not view the Johnson decision as dispositive. Instead, compensating a
miner's survivors where the miner's suicide is causally linked to
pneumoconiosis is consistent with workers' compensation principles and
underlying Congressional intent.
The final rule also clarifies the Department's longstanding view
that suicide does not preclude entitlement once the survivor invokes
the Section 411(c)(3) irrebutable presumption of entitlement by
establishing that the miner suffered from complicated pneumoconiosis.
This result is
[[Page 59104]]
compelled by the presumption's plain language. The provision is simply
written: ``If a miner is suffering or suffered from a chronic dust
disease of the lung [that is described by the statutory criteria for
complicated pneumoconiosis], then there shall be an irrebuttable
presumption that he is totally disabled due to pneumoconiosis or that
his death was due to pneumoconiosis, or that at the time of his death
he was totally disabled by pneumoconiosis[,] as the case may be.'' 30
U.S.C. 921(c)(3). The language of the presumption itself renders the
cause of the miner's death--even a death by suicide--irrelevant to the
entitlement inquiry. ``[T]he presumption operates conclusively to
establish entitlement to benefits.'' Usery v. Turner Elkhorn Mining
Co., 428 U.S. 1, 11 (1976). The Supreme Court explained in upholding
Section 411(c)(3) against constitutional challenge that the
presumption's effect ``is to grant benefits to the survivors of any
miner who during his lifetime had complicated pneumoconiosis arising
out of employment in the mines, regardless of whether the miner's death
was caused by pneumoconiosis.'' Id. at 24 (emphasis added). Although
the Court acknowledged that an unrelated death ``can hardly be termed a
`cost' of the operator's business,'' it still concluded that the
``clear'' intent of the presumption was not to provide benefits
``simply as compensation for damages due to the miner's Death, but as
deferred compensation for injury suffered during the miner's lifetime
as a result of his illness itself.'' Id. at 25. See also Gray v. SLC
Coal Co., 176 F.3d 382, 386-87 (6th Cir. 1999) (agreeing with
Department's view that Sec. 718.205(c)(4) traumatic injury provision
does not preclude survivor of miner who committed suicide from pursuing
benefits under Section 411(c)(3) presumption); USX Corp. v. Director,
OWCP, 19 F.3d 1431 (4th Cir. 1994) (unpublished table decision) (citing
Usery and affirming survivor's benefits award under Section 411(c)(3),
notwithstanding Sec. 718.205(c)(4), where miner's death was caused by
a non-work-related tractor accident).
In sum, the final rule allows the survivors of a miner who
committed suicide to prove death due to pneumoconiosis by demonstrating
either that the suicide was causally linked to pneumoconiosis or by
invoking the Section 411(c)(3) irrebutable presumption of entitlement.
The Department believes these changes will have little practical impact
on claim adjudications given the ACA's revitalization of automatic
survivors' entitlement, which also makes the cause of a miner's death
irrelevant if the miner was entitled to lifetime benefits. If the
miner's claim was not awarded, the Department anticipates that his
survivors will be able to demonstrate a link between disease and
suicide only in rare cases.
(c) No further comments on this section were received and the
Department has promulgated the remainder of the regulation as proposed.
20 CFR 718.305 Presumption of pneumoconiosis
(a) Section 718.305 implements the Section 411(c)(4) 15-year
presumption. This statutory section provides a rebuttable presumption
of total disability or death due to pneumoconiosis if the miner ``was
employed for fifteen years or more in one or more underground coal
mines'' or in a coal mine other than an underground mine in conditions
``substantially similar to conditions in an underground mine'' and
suffers or suffered from ``a totally disabling respiratory or pulmonary
impairment.'' 30 U.S.C. 921(c)(4). Because current Sec. 718.305
describes the presumption's requirements using language largely taken
verbatim from the statute and offers little additional guidance
regarding how the presumption may be invoked or rebutted, the
Department proposed substantial revisions to clarify the presumption's
operation. The proposed rule also eliminated obsolete provisions.
(b) Invocation. Three comments object to proposed Sec.
718.305(b)(2), which states that ``[t]he conditions in a mine other
than an underground mine will be considered `substantially similar' to
those in an underground mine if the miner was exposed to coal-mine dust
while working there.'' 77 FR at 19475. The Department explained in the
preamble that under this standard, a claimant would not need to produce
evidence about underground mining conditions and that it was incumbent
upon the fact finder to compare the claimant's non-underground mining
exposure with those conditions known to exist in underground mines. 77
FR at 19461. The Department cited several circuit court cases,
including Director, OWCP v. Midland Coal Co., 855 F.2d 509, 512 (7th
Cir. 1988), and Benefits Review Board cases which had adopted this
approach.
The commenters that object to this section point out that although
the preamble states that the fact finder must compare the miner's non-
underground mine exposure with underground mine conditions, the
regulation itself only requires that a claimant demonstrate some coal-
mine-dust exposure in non-underground mining. They contend this is
contrary to the statute's plain language because it does not require
the claimant to prove any type of similarity between exposures in
underground and non-underground work. The comments also state that the
Department should adopt an objective standard for proving substantial
similarity (although no comment suggests a particular standard) and
that the test should take into consideration certain studies showing
that non-underground miners rarely develop disabling pneumoconiosis.
One comment notes that administrative law judges do not necessarily
have the requisite expertise to compare an individual non-underground
miner's exposure to usual conditions in underground mining. Another
comment suggests that OWCP confer with the Mine Safety and Health
Administration and the National Institutes of Health to develop a
standard.
Two comments support proposed Sec. 718.305(b)(2) and the adoption
of the Midland Coal standard. One states that it is a common sense rule
that administrative law judges have had no problem applying. The
commenters argue that any rule that requires a claimant to quantify a
miner's dust exposure would be impractical. The commenters also note
that the potential exposure in non-underground mining is actually
greater than in underground mining because no ventilation systems
mitigate the exposure. These comments also disagree with the other
commenters' representations that certain medical studies demonstrate
non-underground miners are not at increased risk for pneumoconiosis,
especially once silicosis is taken into account.
The Department has revised Sec. 718.305(b)(2) to clarify the
standard. The Department agrees with those comments that noted the
proposed rule could be interpreted as allowing a ``substantial
similarity'' finding when the miner was exposed to any coal-mine dust
in non-underground coal mining. This would not satisfy the statutory
standard and was not the Department's intent.
The final rule's revised language clarifies the Department's intent
about how the substantial similarity analysis should be conducted. The
final rule acknowledges, as the Seventh Circuit recognized in Midland
Coal, a fundamental premise underlying the BLBA, as demonstrated by the
legislative history, i.e., that ``underground mines are dusty.''
Midland Coal, 855 F.2d at 512. Given
[[Page 59105]]
that legislative fact, it is unnecessary for a claimant to prove
anything about dust conditions existing at an underground mine for
purposes of invoking the 15-year presumption. Instead, the claimant
need only focus on developing evidence addressing the dust conditions
prevailing at the non-underground mine or mines at which the miner
worked. The objective of this evidence is to show that the miner's
duties regularly exposed him to coal mine dust, and thus that the
miner's work conditions approximated those at an underground mine. The
term ``regularly'' has been added to clarify that a demonstration of
sporadic or incidental exposure is not sufficient to meet the
claimant's burden. The fact-finder simply evaluates the evidence
presented, and determines whether it credibly establishes that the
miner's non-underground mine working conditions regularly exposed him
to coal mine dust. If that fact is established to the fact-finder's
satisfaction, the claimant has met his burden of showing substantial
similarity. And if the periods of regular exposure in non-underground
mine employment (combined with any underground mine employment) total
15 years or more, the claimant will be entitled to invoke the
presumption if a total respiratory or pulmonary disability is also
established. This procedure will also alleviate one commenter's concern
that some administrative law judges may not be knowledgeable about
conditions in underground mines.
To the extent the comments urge the Department to adopt technical
comparability criteria, such as requiring a claimant to produce
scientific evidence specifically quantifying the miner's exposure to
coal mine dust during non-underground mining, the Department rejects
the suggestion. Benefit claimants, who must bear the burden of proving
substantial similarity to invoke the presumption, generally do not
control this type of technical information about the mines in which the
miner worked. See generally Usery, 428 U.S. at 29 (noting that
``showing of the degree of dust concentration to which a miner was
exposed [is] a historical fact difficult for the miner to prove.'').
Instead, the coal mine operators control dust-sampling and similar
information about their mines. While this information is publicly
available from the Mine Safety and Health Administration for some
mines, it may not be relevant or available in any particular case. Dust
sampling in non-underground mines is done on a designated-position
basis (e.g., bulldozer operator, driller). See generally 30 CFR 71.201
et seq. Thus, the results may not be relevant to miners doing other
jobs and certainly would not be an adequate basis for the Department to
adopt an exposure rule for all non-underground miners.
Instead, the Department believes the standard should be one that
may be satisfied by lay evidence addressing the individual miner's
experiences. Congress enacted the Section 411(c)(4) presumption to
assist miners and their survivors in establishing entitlement to
benefits, and also permitted certain claimants to prove entitlement by
lay evidence. 30 U.S.C. 923(b). Putting insurmountable hurdles in
claimants' paths does not comport with that intent. Moreover, because a
claimant's dust exposure evidence will be inherently anecdotal, it
would serve no purpose for the Department to develop an objective, and
therefore dissimilar, benchmark of underground mine conditions for
comparison purposes. The legislative fact that underground coal mines
are dusty is fully sufficient for this purpose. Of course, nothing
would preclude a coal mine operator from introducing evidence--
including any technical data within its control--showing that the
particular miner was not regularly exposed to coal mine dust during his
non-underground coal mine employment.
The Department also does not believe that reviewing current medical
and scientific literature on the prevalence of pneumoconiosis in non-
underground miners would be useful in promulgating this particular
rule. By explicitly making the presumption available to at least some
non-underground miners, Section 411(c)(4) finds as a legislative fact
that these miners can develop pneumoconiosis. Moreover, the statute
focuses the substantial similarity question on a comparison of
conditions existing at the different types of mines, not on the medical
question of whether certain exposures do or do not lead to
pneumoconiosis. See Midland Coal, 855 F.2d at 512 (``Congress focused
specifically on dust conditions in enacting the `substantial
similarity' provision.'') The Department is not free to depart from
Congress' express intent on this issue. If the particular miner did
not, in fact, suffer from pneumoconiosis, the coal mine operator will
be able to rebut the presumption.
(c) Rebuttal. The Department proposed Sec. 718.305(d) to set out
the burden of proof on the party opposing entitlement to rebut the
presumption in both miners' and survivors' claims. The proposed
rebuttal standards were modeled on language contained in both the
statutory presumption itself and current Sec. 718.305(d), which were
used in claims filed before January 1, 1982. Applying the statutory
limitations imposed on rebuttal, proposed Sec. 718.305(d) provided
that the party opposing entitlement could rebut the presumption in only
two ways: Showing that the miner did not have pneumoconiosis or that
his disability or death did not arise out of coal-mine-dust exposure.
For this second method, proposed Sec. 718.305(d)(1)(ii) (for miners'
claims) and Sec. 718.305(d)(2)(ii) (for survivors' claims) provided
that the presumption could be rebutted by proof that the miner's
respiratory disability or death ``did not arise in whole or in part out
of dust exposure in the miner's coal mine employment.'' 77 FR at 19475.
The Department explained in the preamble that this language had been
interpreted by the courts, in both Section 411(c)(4) and the similar 20
CFR 727.203(b)(3) context, as requiring the party opposing entitlement
to ``rule out'' coal mine employment as a cause of the miner's
disabling respiratory or pulmonary impairment. 77 FR at 19463.
One commenter argues that the limitations on rebuttal set forth in
Section 411(c)(4) do not apply to coal mine operators under the Usery
decision. Several comments acknowledge that the ``in whole or in part''
standard in the proposed rule is the equivalent of the ``rule-out''
standard mentioned in the preamble, but express disagreement with the
rule-out standard. They note that claimants who attempt to establish
entitlement without benefit of the presumption must show that
pneumoconiosis was a ``substantially contributing cause'' of disability
or death, and cannot recover if pneumoconiosis was only an
insignificant or ``de minimis'' cause of disability or death under
current Sec. 718.204(c)(1) and Sec. 718.205(c)(2). They also contend
that a ``rule-out'' requirement improperly imposes a different standard
on operators because it requires them to establish that pneumoconiosis
was not even an insignificant or de minimis cause of disability or
death. One comment argues that by including the ``rule-out'' standard
in the preamble (rather than the regulatory text), the Department has
violated its duty to publish its rules for public comment. This comment
contends that if the ``rule-out'' standard is intended to establish a
party's burden of proof on rebuttal, it violates the Administrative
Procedure Act (APA) as construed by the Supreme Court in Director, OWCP
v. Greenwich Collieries, 512 U.S. 267 (1994). This comment also states
that if the ``rule-out'' standard is intended to define the legal
criteria for
[[Page 59106]]
rebuttal, it has no authoritative source and is inconsistent with the
``reasonable medical certainty'' standard it asserts applies in BLBA
claim adjudications.
Two comments generally support the proposed rule. One states that
the presumption should be strong and remarks that ensuring operators'
liability for coal-mine related lung disease creates an incentive for
operators to comply with dust-control standards.
The final rule adopts an approach similar to the proposed rule. But
the Department has made several revisions to clarify the rebuttal
provisions and to accommodate some of the concerns expressed in the
comments. We explain those changes below.
Miners' claims. A miner seeking BLBA benefits is required to
establish, with direct evidence or via presumption, four elements of
entitlement: (1) Disease: that the miner suffers from pneumoconiosis in
clinical or legal form, or both; (2) disease causation: that the
pneumoconiosis arose at least in part out of coal mine employment; (3)
disability: that the miner has a pulmonary or respiratory impairment
that prevents the performance of the miner's usual coal mine work; and
(4) disability causation: that the miner's pneumoconiosis contributes
to that disability. 20 CFR 725.202(d)(2); see, e.g., Morrison v. Tenn.
Consol Coal Co., 644 F.3d 473, 478 (6th Cir. 2011); Lane v. Union
Carbide Corp., 105 F.3d 166, 170 (4th Cir. 1997). If a miner proves the
disability element by a preponderance of the evidence, then Section
411(c)(4) presumes the remaining three entitlement elements. But
because the presumption is rebuttable, the party opposing entitlement
must be given an opportunity to show by a preponderance of the evidence
that the three presumed elements (disease, disease causation, and
disability causation) are not in fact present. If the opposing party
establishes that the miner does not have a lung disease related to coal
mine employment (elements one and two) or that the miner's totally
disabling respiratory or pulmonary impairment is unrelated to his
pneumoconiosis (element four), the presumption is rebutted.
The Department has revised Sec. 718.305(d) in this final rule to
more clearly reflect that all three of the presumed elements may be
rebutted. Section 718.305(d)(1)(i) provides that the party opposing
entitlement may rebut the presumption by proving that the miner has
neither legal nor clinical pneumoconiosis, including where the miner's
clinical pneumoconiosis did not arise from covered coal mine employment
(disease and disease causation). See Barber v. Director, OWCP, 43 F.3d
899, 901 (4th Cir. 1995) (party rebutting Section 411(c)(4) presumption
must demonstrate absence of both clinical and legal pneumoconiosis); 77
FR at 19462-63 (same). Section 718.305(d)(1)(ii) provides that rebuttal
may also be accomplished when the party opposing the claim shows that
no part of the miner's respiratory disability was caused by
pneumoconiosis (disability causation). See generally Mingo Logan Coal
Co. v. Owens, ------ F.3d ------, ------, 2013 WL 3929081, *4 (4th Cir.
2013) (outlining three elements available for rebuttal under Section
411(c)(4)).
These revisions also should relieve the concern expressed in the
comments that the limitations Section 411(c)(4) places on rebuttal are
not applicable to coal mine operators. Enacted in 1972, Section
411(c)(4) provides that ``[t]he Secretary may rebut such presumption
only by establishing that (A) such miner does not, or did not, have
pneumoconiosis, or that (B) his respiratory or pulmonary impairment did
not arise out of, or in connection with, employment in a coal mine.''
In 1976, the Supreme Court held that ``the Sec. 411(c)(4) limitation
on rebuttal evidence is inapplicable to operators.'' Usery, 428 U.S. at
35. Nevertheless, when the Department adopted Sec. 718.305 in 1980, it
listed the same two exclusive methods of rebuttal, but did not limit
their application to the Secretary. The explanation for the change is
simple. The 1978 amendments to the BLBA expanded the definition of
``pneumoconiosis'' to include what is now known as ``legal
pneumoconiosis,'' i.e., any ``chronic lung disease or impairment . . .
arising out of coal mine employment.'' 20 CFR 718.201(a)(2). This
amendment rendered proof that a miner's disability resulted from a lung
disease caused by coal dust exposure that was not pneumoconiosis no
longer a valid method of rebuttal because every disabling lung disease
caused by coal dust exposure is legal pneumoconiosis. Thus, the
scenario motivating Usery's discussion of the rebuttal-limiting
sentence no longer exists: The only ways that any liable party--whether
a mine operator or the government--can rebut the 15-year presumption
are the two set forth in the presumption, which encompass the disease,
disease-causation, and disability-causation entitlement elements.
Authorities post-dating this amendment that state the coal mine
operator is limited to the statutory rebuttal methods simply reflect
that fact. See, e.g., Rose v. Clinchfield Coal Co., 614 F.2d 936, 939
(4th Cir. 1980).
The Department does not believe that the comment's discussion of
Supreme Court decisions limiting an agency's power to re-interpret
statutes that have been construed by the Court as unambiguous compels
the Department to limit the proposed rebuttal standards to the
Secretary. See Nat'l Cable & Telecomms. Ass'n v. Brand X Internet
Servs., 545 U.S. 967 (2005), United States v. Home Concrete & Supply,
Inc., -- U.S. --, 132 S. Ct. 1836 (2012). These cases are beside the
point: Neither forbid an agency from adopting a regulation that
conflicts with a prior judicial decision when the new regulation is
compelled by a subsequent amendment to the statute. Moreover, as
already discussed, there simply are no other facts presumed under the
Sec. 411(c)(4) presumption that a coal mine operator could rebut.
Thus, the Department believes that applying the Sec. 718.305(d)
rebuttal standards to all parties opposing entitlement, as proposed,
will prove more helpful to the regulated public by informing it of the
ways it can rebut the presumption.
The Department is also not persuaded by those comments that
advocate applying the ``substantially contributing cause'' standard for
disability causation set forth at Sec. 718.204(c)(1) to the Sec.
718.305(d) rebuttal standard. The comments correctly state that the
proposed rules apply a different disability-causation standard to
claims governed by the general Part 718 criteria than those in which
the miner successfully invokes the Section 411(c)(4) presumption. But
that difference is warranted by the statutory section's underlying
intent and purpose. Based on evidence that miners who worked for at
least fifteen years were more likely to develop pneumoconiosis,
Congress chose to extend the presumption only to those miners who
worked in the mines for at least fifteen years and who were totally
disabled by respiratory or pulmonary impairments. See generally S. Rep.
No. 92-743 at 13 (1972), reprinted in 1972 U.S.C.C.A.N. 2305, 2316-17.
Congress adopted the presumption to ``[r]elax the often insurmountable
burden of proving eligibility'' these miners faced. S. Rep. No. 92-743
at 1. In short, Congress effectively singled out these miners for
special treatment. Adopting a rigorous rebuttal standard in those
limited circumstances in which the opposing party cannot demonstrate
the absence of coal-mine-related pneumoconiosis (and thus can only
rebut by showing that the
[[Page 59107]]
miner's disability is not related to pneumoconiosis) is consistent with
Congress' approach. See generally Consolidation Coal Co. v. Director,
OWCP, 721 F.3d 789, 795 (7th Cir. 2013) (noting ``[i]t is no secret
that the 15-year presumption is difficult to rebut'').
The Department has consistently interpreted Section 411(c)(4) as
requiring the rebutting party to show that the miner's disability did
not arise ``in whole or in part'' from coal mining. See 20 CFR
718.305(d) (2012). And the courts considering the rebuttal provisions
have concurred with the Department's use of the ``in whole or in part''
standard. See, e.g., Blakley v. Amax Coal Co., 54 F.3d 1313, 1320 (7th
Cir. 1995); Bosco v. Twin Pines Coal Co., 892 F.2d 1473, 1481 (10th
Cir. 1989); Rose, 614 F.2d at 939; Colley & Colley Coal Co. v.
Breeding, 59 Fed. Appx. 563, 567 (4th Cir. Mar. 11, 2003) (unpub.). The
``in no part'' standard the Department has adopted in the final rule is
a reasonable interpretation of the statutory language and effectuates
Section 411(c)(4)'s purposes. It is intended to simplify and clarify
the ``in whole or in part standard.''
Contrary to one commenter's suggestion, the Sec. 718.305(d)
rebuttal standards adopted by the final rule do not violate the burden
of proof imposed by the APA. As interpreted by the Supreme Court, the
APA requires the proponent of a rule or order to bear the burden of
persuasion by a preponderance of the evidence to prevail. Greenwich
Collieries, 512 U.S at 277-78. The ``in no part'' standard does not run
afoul of this holding because it is the fact that must be established
and not the ``degree of certainty needed to find a fact or element
under the preponderance standard.'' Metropolitan Stevedore Co. v.
Rambo, 521 U.S. 121, 129 (1997). As the Supreme Court has explained,
``the preponderance standard goes to how convincing the evidence in
favor of a fact must be in comparison with the evidence against it
before that fact may be found, but does not determine what facts must
be proven as a substantive part of a claim or defense.'' Id. (citing
Greenwich Collieries v. Director, OWCP, 990 F.2d 730, 736 (3d Cir.
1993)). The ``in no part'' standard also does not govern the level of
certainty with which a medical opinion must be expressed to be
considered probative evidence; the rule provides only what facts must
be established to rebut the presumption. Thus, the commenter's fears
that the standard requires a higher level of certainty in medical
opinions than is currently required are unfounded. Moreover, contrary
to the commenter's statement, a medical opinion need not be expressed
with ``reasonable medical certainty'' to be probative of a medical fact
under the BLBA. Instead, it is sufficient if the opinion is documented
and constitutes a reasoned medical judgment. See, e.g., Mancia v.
Director, OWCP, 130 F.3d 579, 588 (3d Cir. 1997). Thus, a party
opposing entitlement may rebut the presumption when the preponderance
of the evidence, including medical opinions that are documented and
reasoned exercises of physicians' medical judgment, demonstrates that
pneumoconiosis played no role in the miner's respiratory disability.
Survivors' claims. In the survivor's context, a claimant who
establishes the invocation criteria receives a presumption that the
miner died due to pneumoconiosis. This presumption encompasses the two
entitlement elements in survivors' claims: Disease (that the miner had
clinical and legal pneumoconiosis) and death (that the miner died due
to pneumoconiosis). For the reasons stated above regarding rebuttal in
a miner's claim, the Department has made parallel changes to Sec.
718.305(d)(2) in this final rule to clarify how the presumption may be
rebutted when the party opposing entitlement seeks to disprove these
presumed facts.
(d) No further comments were received and the Department has
promulgated the remainder of the regulation as proposed.
20 CFR 725.212, 725.218, 725.222 Conditions of entitlement
(a) This series of rules prescribes the conditions required for a
miner's survivors to establish entitlement to benefits. Section 725.212
applies to a miner's surviving spouse or a surviving divorced spouse,
Sec. 725.218 applies to a deceased miner's children, and Sec. 725.222
applies to surviving parents and siblings. The Department proposed
revising these regulations to omit certain conditions of entitlement
applicable only to claims filed prior to June 30, 1982, and to add new
conditions of entitlement made applicable to certain claims by the ACA
amendments. Specifically, ACA Section 1556(b) amended Section 422(l) to
revive automatic entitlement for survivors of miners awarded lifetime
disability benefits and whose claims meet the effective date
requirements of ACA Section 1556(c). Proposed Sec. Sec.
725.212(a)(3)(ii), 725.218(a)(2), and 725.222(a)(5)(ii) implement this
amendment by clarifying that qualifying survivors who file a claim for
survivors' benefits after January 1, 2005, that is pending on or after
March 23, 2010, are not required to establish that the miner died due
to pneumoconiosis. 77 FR at 19467; 19477-78.
(b) Two commenters, who submitted identical comments, object
generally to the Department's construction of the statute. They argue
that the ACA restores derivative benefits to survivors only if the
related miner's disability claim was filed after January 1, 2005, and
pending on or after March 23, 2010. One commenter generally supports
the Department's proposal to implement the ACA amendment restoring
derivative survivors' benefits.
The Department continues to believe, as explained in the proposal
(77 FR at 19467-68), that the ACA amendments apply to all claims,
including survivors' claims, meeting the effective date criteria. The
plain language of Section 1556(c) states that the amendments apply to
``claims filed . . . after January 1, 2005, that are pending on or
after [March 23, 2010].'' Public Law 111-148, 1556(c), 124 Stat. 119,
260(c) (2010). Nothing in the text of ACA Section 1556(c) or Section
1556(b) suggests that the amendment only applies to disability claims
by miners and not to survivors' claims. To the contrary, the most
natural reading of the unqualified word ``claims'' in Section 1556(c)
encompasses both miners' and survivors' claims. The four courts that
have considered the issue have unanimously agreed with this reading and
held that the amendment restoring derivative benefits applies to
survivors' claims that satisfy Section 1556(c)'s effective-date
requirements even if the related miner's disability claim did not. See
Marmon Coal Co. v. Director, OWCP [Eckman], ------ F.3d ------, ------
n.3, 2013 WL 4017160, *6 n.3 (3d Cir. 2013) (``the ACA revives Sec.
932(l)'s automatic benefits to the extent that a survivor files a claim
for benefits after January 1, 2005, that is pending on or after the
ACA's effective date, March 23, 2010.''); U.S. Steel Mining v.
Director, OWCP [Starks], 719 F.3d 1275, 1285 (11th Cir. 2013)
(``Section 1556(c) does not distinguish between miners' claims and
survivors' claims. The plain meaning of Sec. 1556(c) is that anyone--
miner or survivor--who filed a claim for benefits after January 1,
2005, that remained pending on March 23, 2010, can receive the benefit
of the amendments.''); Vision Processing, LLC v. Groves, 705 F.3d 551,
555 (6th Cir. 2013) (``Language and context show that the 2010
amendments apply to all survivor-benefit and all miner-benefit claims
filed after January 1, 2005, and pending on March 23, 2010.''); West
Virginia CWP Fund v. Stacy, 671 F.3d 378, 388 (4th Cir. 2011)
[[Page 59108]]
(``Because Congress used the term `claims' [in ACA Section 1556(c)]
without any qualifying language, and because both miners and their
survivors may file claims under the BLBA . . . the plain language
supports the Director's position that amended Sec. 932(l) applies to
survivors' claims that comply with Section 1556(c)'s effective date
requirements.'').
The Department's conclusion is further informed by Section
1556(c)'s impact on non-survivor claims. Section 1556(c)'s effective-
date requirements apply not just to claims subject to revived Section
422(l) (Section 1556(b)), but also to claims subject to the revived
Section 411(c)(4) 15-year presumption (Section 1556(a)). The 15-year
presumption explicitly applies to claims brought by both miners and
survivors. See 30 U.S.C. 921(c)(4). The commenters' proposed statutory
construction would create an inappropriate dichotomy: the term
``claims'' in subsection (c) would mean ``miners' and survivors'
claims'' when considering entitlement to the fifteen-year presumption
under subsection (a), but only ``miners' claims'' when considering
entitlement to derivative benefits under subsection (b). This
incongruous result violates the ``basic canon of statutory construction
that identical terms within an Act bear the same meaning.'' Estate of
Cowart v. Nicklos Drilling Co., 505 U.S. 469, 479 (1992). Indeed, the
Fourth Circuit has rejected this construction as ``tortured.'' Stacy,
671 F.3d at 389.
To further support their position, the commenters note that because
Section 422(l) ostensibly relieves survivors of the obligation to file
claims, it is illogical to use the survivor's claim filing date as the
operative date for determining eligibility under Section 422(l). The
context in which Congress adopted the ACA amendments leads to a
different conclusion. At the time Section 1556 was enacted, both miners
and survivors filed claims. Indeed, except for the survivors of miners
who had filed successful claims before 1982, the only way a survivor
could obtain benefits was to file an independent claim, even if the
miner had been awarded lifetime disability benefits. See, e.g., Hill v.
Peabody Coal Co., 94 Fed. Appx. 298, 299 (6th Cir. 2004) (unpub.).
Thus, Congress knew when it restored derivative benefits in 2010 that
independent survivors' claims were common. See generally Vimar Seguros
y Reaseguros, S.A. v. M/V Sky Reefer, 515 U.S. 528, 554 (1995)
(Congress is presumed to know the law, and to know how it has been
interpreted.). Interpreted in that light, the term ``claim'' includes
both miners' and survivors' claims. See Starks, 719 F.3d at 1285
(``Just because the application of the amended Sec. 932(l) to a claim
operates to eliminate the need for that claim does not render its
application illogical or unworkable.''); Stacy, 671 F.3d at 388-89
(``Although amended Sec. 932(l) states that a survivor is not required
to file a new claim for benefits, the conclusion petitioner draws from
this language--that the operative date for determining eligibility
cannot be the date the survivor's claim was filed--simply does not
follow.''); Groves, 705 F.3d at 556 (``Section 1556(b) eliminates the
requirement that survivors file a claim before obtaining benefits; it
does not prohibit such claims.''). See also B & G Constr. Co. v.
Director, OWCP [Campbell], 662 F.3d 233, 244 n.12 (3d Cir. 2011)
(``[S]urely a widow seeking benefits must file something in order to
receive them. After all, notwithstanding section 1556 a claimant might
not be the miner's real widow. But what a widow does not have to do is
establish that the miner died from pneumoconiosis.'').
The commenters also state that the proposed rule is inconsistent
with how the Department interpreted the 1982 amendment to Section
422(l) eliminating derivative benefits in claims filed after 1981. The
Department then permitted derivative benefits in survivors' claims
filed after 1981 so long as the related miner's disability claim was
filed before 1982 and resulted in an award. The commenters cite
Pothering v. Parkson Coal Co., 861 F.2d 1321 (3d Cir. 1988), to support
their view. Pothering, which interpreted the text of the 1981
amendment, has no bearing on the meaning of Section 1556(c), which uses
entirely different language. The Department's interpretation of the
1981 amendment's use of the term ``claim'' as meaning only miners'
claims was compelled by its particular text and legislative history,
which are inapplicable to Section 1556. As noted above, the Third
Circuit itself has confirmed that the ACA's automatic entitlement
provisions apply to survivors' claims filed within Section 1556's
temporal limitations. Eckman, ------ F.3d at ------ n.3, 2013 WL
4017160, *6 n.3. Other courts confronted with the Pothering argument
have either specifically or implicitly rejected it. See Starks, 719
F.3d at 1286 (rejecting Pothering argument and noting that ``[i]f [the
Section 1556] context does not demand a variation in the meaning of the
word `claim,' we do not know what context would. Any other reading of
the word in this context is . . . tortured.'') (internal quotation
marks omitted); Stacy, 671 F.3d at 388-89; Groves, 705 F.3d at 555-56.
(c) No other comments were received concerning these sections, and
the Department has promulgated these regulations as proposed.
20 CFR 725.309 Additional claims; effect of a prior denial of benefits
(a) Section 725.309 addresses both the filing of additional claims
for benefits and the effect of a prior denial. In its notice of
proposed rulemaking, the Department proposed to revise the current rule
to clarify how the ACA amendment restoring Section 422(l) derivative-
survivors' benefits applies when a survivor files a subsequent claim.
77 FR at 19467-68; 19478. The proposed rule added a new paragraph,
Sec. 725.309(d)(1), to clarify that a survivor need not establish a
change in a condition of entitlement if the subsequent claim meets the
requirements for entitlement under amended Section 422(l). The proposed
rule also limited this exception to survivors whose prior claims were
finally denied prior to March 23, 2010, i.e., before the ACA was
enacted. Once a survivor files a claim subject to the ACA and that
claim is denied, any subsequent claim the survivor files is subject to
the usual rules of claim preclusion set forth in proposed Sec.
725.309(c) because the subsequent claim asserts the same cause of
action as the prior denied claim.
(b) The Department received five comments asking it to abandon the
proposed rule. These commenters list several related reasons for their
request. They assert that ``re-opening'' denied survivors' claims
violates the doctrine of res judicata, and that the ACA amendments do
not create a new cause of action that would justify an exception to the
doctrine or otherwise allow for re-opening of previously denied
survivor claims. The commenters also suggest that the proposed rule
violates ACA Section 1556(c), which restricts application of the
amendments to claims filed after January 1, 2005. Finally, one
commenter stated that the proposed rule does not clearly convey the
Department's intent.
Two comments support the proposed rule. One contends that the
Department's decision to allow survivors to file subsequent claims is
both compelled by the statute's remedial purposes and consistent with
res judicata concepts.
Although the Department declines to abandon the proposed rule, the
final rule has been revised to more clearly convey the Department's
intent. Specifically, the final rule
[[Page 59109]]
comprehensively describes the universe of survivors who are exempt from
having to prove a change in a condition of entitlement under Sec.
725.309(d) to pursue a subsequent claim. The proposed rule
inadvertently excluded survivors whose prior claims were filed on or
before January 1, 2005 that remained pending after the ACA's March 23,
2010 enactment date. As explained in the NPRM, 77 FR at 19468, and
discussed in detail below, the ACA's revival of Section 422(l)'s
automatic survivor entitlement provision created a new cause of action.
Thus, these survivors may take advantage of the amendment by filing a
subsequent claim without being hindered by the findings made in the
prior claim. Accordingly, the Department has modified Sec.
725.309(c)(1) by adding two subparagraphs (Sec. Sec. 725.309(c)(1)(i)-
(ii)) to provide explicit filing and pendency date requirements for the
prior claim that cover all survivor claims not previously adjudicated
under amended Section 422(l). With this change, the final rule also
makes clear that only a survivor whose prior claim was not subject to
the Section 422(l) amendment may be found entitled to benefits on a
subsequent claim without having to establish a change in a condition of
entitlement.
The Department is not persuaded by the comments that argue against
allowing subsequent survivors' claims in these circumstances. The
commenters' underlying assumption--that the Department's proposed rule
re-opens previously denied claims--misperceives the rule. As the
Department emphasized in its proposal, 77 FR at 19468, the ACA does not
authorize reopening of previously denied claims and the proposed rule
was not intended to reopen denied survivors' claims. See generally
Eckman, ------ F.3d at ------, 2013 WL 4017160, *5 (a subsequent claim
is a ``new assertion[] of entitlement'' that does not re-open a prior
denied claim or ``disregard principles of finality and res judicata'');
Union Carbide Corp. v. Richards, 721 F.3d 307, 314 (4th Cir. 2013)
(``[R]es judicata is not implicated by [subsequent survivors'] claims
since entitlement under Section 932(l), as revived by Section 1556,
does not require relitigation of the prior findings that the miners'
deaths were not due to pneumoconiosis.''). Instead, consistent with the
plain language of the ACA, the rule is intended to make automatic
entitlement available in subsequent claims, which are entirely new
assertions of entitlement distinct from any previous claim. See Lovilia
Coal Co. v. Harvey, 109 F.3d 445, 449 (8th Cir. 1997) (a ``claim''
under the BLBA refers to a distinct application for benefits, not an
operator's general liability to a particular claimant).
Importantly, the rule leaves the survivor's prior claim decision,
and its underlying findings, in effect. This means that the survivor
will not be entitled to benefits for any period of time pre-dating the
prior denial. See 77 FR at 19468. Consequently, the rule is consistent
with the Department's longstanding recognition that, for purposes of a
subsequent claim, ``the correctness of [the prior decision's] legal
conclusion'' must be accepted in adjudicating the latter application.
Lisa Lee Mines v. Director, OWCP, 86 F.3d 1358, 1361 (4th Cir. 1996)
(en banc); see also Richards, 721 F.3d at 317 & n.5 (limiting benefits
period on subsequent survivor's claim to period after prior claim
denial provides claimant ``meaningful benefits'' while also
``mitigat[ing] the burden to the operator and respect[ing] the validity
of the earlier denial.'').
The commenters are also incorrect that the doctrine of res judicata
precludes application of section 422(l) to a survivor's subsequent
claim. Res judicata ``bars a party from suing on a claim that has
already been `litigated to a final judgment by that party . . . and
precludes the assertion by such parties of any legal theory, cause of
action, or defense which could have been asserted in that action.' ''
Ohio Valley Envtl. Coal. v. Arcoma Coal Co. (OVEC), 556 F.3d 177, 210
(4th Cir. 2009) (quoting 18 James Wm. Moore et al., Moore's Federal
Practice Sec. 131.10(1)(a) (3d ed. 2008). For res judicata to bar a
subsequent action, ``three elements must be present: (1) A judgment on
the merits in a prior suit resolving (2) claims by the same parties . .
. , and (3) a subsequent suit based on the same cause of action.''
OVEC, 556 F.3d at 210 (internal quotation marks omitted). Res judicata
is not applicable in this situation because a subsequent claim for
automatic entitlement, arising by virtue of the ACA's 2010 amendment of
the BLBA, is not the same cause of action as the original claim.
Eckman, ------ F.3d at ------, 2013 WL 4017160, *6 (holding that a
survivor's ``subsequent claim thus involves a different cause of
action, and res judicata does not prevent [the survivor] from receiving
survivors' benefits under the BLBA.'').
The Department does not disagree with the notion, as expressed by
one commenter, that causes of action are generally defined by a
``transactional'' approach. Citing various legal precedents, the
commenter states that a cause of action arises out of a common nucleus
of facts and does not depend on a particular theory of recovery. It is
undoubtedly correct that ``[a] claim [that] existed at the time of the
first suit and `might have been offered' in the same cause of action, .
. . is barred by res judicata.'' Aliff v. Joy Mfg. Co., 914 F.2d 39,
43-44 (4th Cir. 1990). But a claim that did not exist at the time of
the prior proceeding, because the new claim could not have been raised
in the prior proceeding, is not so barred. Richards, 721 F.3d at 314-
15; OVEC, 556 F.3d at 210-11. The Supreme Court explained this
principle: ``[w]hile [a prior] judgment precludes recovery on claims
arising prior to its entry, it cannot be given the effect of
extinguishing claims which did not even then exist and which could not
possibly have been sued upon in the previous case.'' Lawlor v. Nat'l
Screen Serv. Corp., 349 U.S. 322, 328 (1955).
Contrary to the commenter's contention, it is well-recognized that
a statutory amendment subsequent to a first action can create a new
cause of action that is not barred by res judicata, even where the new
action is based on the same facts as the prior one. Richards, 721 F.3d
at 315 (``While typically it is a new factual development that gives
rise to a fresh cause of action, changes in law can also have that
effect.'') (internal citations omitted); Alvear-Velez v. Mukasey, 540
F.3d 672 (7th Cir. 2008); Moore et al. at ] 131.22[3] (``when a new
statute provides an independent basis for relief which did not exist at
the time of the prior action, a second action on the new statute may be
justified''). In Alvear-Velez, the Seventh Circuit clearly
differentiated between ``changes in case law [which] almost never
provide a justification for instituting a new action'' and ``statutory
changes that occur after the previous litigation has concluded [which]
may justify a new action.'' 540 F.3d at 678. As to the former, a change
in precedent provides no relief from res judicata because it merely
reflects the error in the prior decision, which the aggrieved party
accepted by not appealing. Id.; Pittston Coal Group v. Sebben, 488 U.S.
105, 122-23 (1988); Moore et al. at ] 131.22[3]. By contrast, no such
appellate remedy is available where a statutory barrier precludes
relief. Alvear-Velez, 540 F.3d at 678 n.4.
Moreover, the second action is permissible where there is a
statutory amendment because ``the rule against claim splitting, which
is one component of res judicata, is inapplicable when a statutory
change creates a course of action unavailable in the previous
[[Page 59110]]
action.'' Alvear-Velez, 540 F.3d at 678. See also Maldonado v. U.S.
Attorney Gen., 664 F.3d 1369, 1377 (11th Cir. 2011) (court rejected a
res judicata defense to the removal of an alien on a new statutory
ground in a second proceeding--although for the same offense as in a
prior proceeding--explaining that ``the doctrine does not say that a
new claim is barred when it is based on a new theory not otherwise
available at the time of the prior proceeding,'' and thus permitted
removal based on the new statutory ground); Ljutica v. Holder, 588 F.3d
119, 127 (2d Cir. 2009) (rejecting res judicata defense to a second
removal proceeding--based on the same crime as the first proceeding--
because Congress created a new ground for removal subsequent to the
first action); Dalombo Fontes v. Gonzales, 498 F.3d 1, 2-3 (1st Cir.
2007) (noting in dicta that res judicata does not apply when Congress
amends the statutory grounds for removal, ``[b]ecause a different and
broader definition [of removal offenses] now controlled and that
definition applied retroactively, the two proceedings did not involve
the same claim or cause of action''); Marvel Characters, Inc., v.
Simon, 310 F.3d 280, 287 (2d Cir. 2002) (rejecting res judicata defense
because amendments to Copyright Act provided plaintiff ``an entirely
new and wholly separate right than the renewal right,'' which could not
have been adjudicated in the first action).
Although one commenter states that ``authorities supporting the
notion that a change in law does not create a new cause of action are
legion,'' the two cases it cites are not persuasive authority on the
issue of a statutory change. The two somewhat dated decisions it cites,
Hurn v. Oursler, 289 U.S. 238 (1933), and Friederichsen v. Renard, 247
U.S. 207 (1918), do not involve the doctrine of res judicta and do not
address whether a change in statutory law would create a new cause of
action.
Even when viewed on a factual level, a survivor's subsequent claim
that meets the ACA's filing and pendency requirements is a different
cause of action. The determination of whether two proceedings involve
the same cause of action requires close analysis of the underlying
facts in each proceeding. See, e.g., Duhaney v. Attorney Gen., 621 F.3d
340, 348 (3d Cir. 2010) (``the focus of the inquiry is whether the acts
complained of were the same, whether the material facts alleged in each
suit were the same, and whether the witnesses and documentation
required to prove such allegations were the same'') (internal quotation
marks omitted). Res judicata, however, does not apply when ``[a]though
there are common elements of fact between the two . . . proceedings,
the critical acts and the necessary documentation were different for
the two proceedings.'' Id. at 349; see also Eckman, ------ F.3d at ----
--, 2013 WL 4017160, *6 (``The mere existence of common elements of
fact between two claims does not establish the same cause of action if
the critical acts and the necessary documentation were different for
the two claims.''); Meekins v. United Transp. Union, 946 F.2d 1054,
1058 (4th Cir. 1991) (res judicata inapplicable where a later suit
``arises from events separate from those at issue in the first suit'').
Moreover, it does not matter that the same ultimate remedy is available
in both the first and second actions, as the cause of action springs
out of the underlying facts, not the remedy. See Duhaney, 621 F.3d at
349.
Applying these principles in the context of survivors entitled
under amended Section 422(l) shows that a subsequent claim is based on
a different factual predicate than an original claim. In an original
claim not subject to the ACA amendments, a survivor could recover only
by proving that the miner's death was due to pneumoconiosis. See 20 CFR
718.205. Resolution of this issue is based on an intensive review of
medical evidence. The adjudicator is required to determine what
condition or conditions resulted in the miner's death, as well as the
etiology of those conditions. In contrast, the cause of the miner's
death is not at issue in a survivor's subsequent claim awarded pursuant
to amended Section 422(l), and medical evidence is wholly irrelevant.
Rather, the survivor's entitlement is based solely on an administrative
fact--whether the miner had been awarded benefits in his lifetime
claim. See 30 U.S.C. 932(l). Thus, ``subsequent claims arise from
operative facts that are separate and distinct from those underlying
[the survivors'] initial claims, and therefore constitute new causes of
action.'' Richards, 721 F.3d at 315. Accord Eckman, ------ F.3d at ----
--, 2013 WL 4017160, *6 (``material facts alleged'' in prior and
subsequent survivor's claims were different; ``the subsequent claim
thus involves a different cause of action'' not barred by res
judicata).
Precluding subsequent claims of survivors in these circumstances
would not further the purposes of the res judicata doctrine in any
event. ``[R]es judicata and collateral estoppel relieve parties of the
cost and vexation of multiple lawsuits, conserve judicial resources,
and, by preventing inconsistent decisions, encourage reliance on
adjudication.'' Allen v. McCurry, 449 U.S. 90, 94 (1980); see generally
18 Wright, Miller & Cooper, Federal Practice and Procedure Sec. 4403
(2d ed. 2002). Where subsequent claims are based on automatic
entitlement, there will be little need for factual development, and
most such claims can be decided in summary fashion without protracted
litigation or the expenditure of significant judicial resources. Res
judicata should be used as a shield against vexatious (harassing)
lawsuits or to conserve resources, not as a sword to defeat plainly
meritorious claims.
Furthermore, the danger of inconsistent decisions between original
and subsequent claims is absent because the subsequent claim represents
a different cause of action. In fact, the danger of inconsistency lies
in the other direction. If res judicata bars survivors' subsequent
claims, there would be different results for similarly situated
survivors who satisfy the ACA requirements based solely on the fact
that one previously failed to prove a fact (death due to
pneumoconiosis) that is now wholly irrelevant. See C.I.R. v. Sunnen,
333 U.S. 591, 599 (1948) (where revenue laws changed following original
litigation, expressing concern that collateral estoppel will result in
unequal treatment of taxpayers in same class). In short, there is no
compelling reason why the doctrine of res judicata should be applied in
situations covered by the rule.
The commenters' assertion that the rule circumvents the ACA's 2005
bar date is also without foundation. The rule applies only to
survivors' claims filed after January 1, 2005 and pending on or after
the ACA's enactment date. It is thus fully consistent with the ACA's
plain language, which makes automatic entitlement applicable to all
qualifying survivors' claims, both original and subsequent. It states,
without qualification, that the amendments to the BLBA ``apply with
respect to claims filed . . . after January 1, 2005, that are pending
on or after [March 23, 2010].'' Public Law 111-148, Sec. 1556(c)
(2010) (emphasis added). This provision makes no distinction between
miners' and survivors' claims, or between original and subsequent
claims. Rather, as the Fourth Circuit has held, ``the plain language of
[Section 1556(c)] requires that amended Sec. 932(l) apply to all
claims [that satisfy Section 1556's time limitations].'' Stacy, 671
F.3d at 388 (emphasis in original). See also Groves, 705 F.3d at 555-
56. Thus, ``the statutory text supports [the] position that amended
Section 932(l) applies to all
[[Page 59111]]
claims that comply with Section 1556(c)'s time limitations, including
subsequent claims.'' Richards, 721 F.3d at 314. Accord Eckman, ------
F.3d at ------, 2013 WL 4017160, *5 (Section 1556(c)'s plain language
``encompasses'' subsequent survivor claims).
Along the same lines, one commenter points to Senator Byrd's post-
enactment statement that the ACA amendments will apply to ``all claims
that will be filed henceforth, including many claims filed by miners
whose prior claims were denied, or by widows who never filed for
benefits following the death of a husband'' as evidence that amended
Section 422(l) is not intended to apply to subsequent claims filed by
survivors. See 156 Cong. Rec. S2083 (daily ed. March 25, 2010). The
commenter has misinterpreted the passage. Even if considered persuasive
authority, see Starks, 719 F.3d at 1283 n.9 (stating that Senator
Byrd's post-enactment statement is not ``legitimate legislative
history''), the Senator's statement is clearly intended simply to
provide illustrative examples of groups who could potentially benefit
from the ACA. See Richards, 721 F.3d at 316 (Senator Byrd's
``description of the scope of the statute as `including' certain types
of claims connotes that his selected examples were intended to be
illustrative of the amendment's reach, not exhaustive.''). Senator Byrd
was not limiting the universe of claims affected by the ACA only to
miners' subsequent claims or survivors' first filings. Indeed, such a
reading would lead to an absurd result since it would exclude miners
who are first-time filers from accessing the revived 15-year
presumption provided under Section 1556(a). Eckman, ------ F.3d at ----
--, 2013 WL 4017160, *4 (concluding that Senator Byrd's list is not
necessarily ``exhaustive'' and pointing out that the list ``does not
include the largest class of potential claims: Original claims filed by
miners, either pending or filed henceforth.'').
One comment argues that the application of Section 1556 to
survivors' subsequent claims likely violates the constitutional
separation-of-powers principle, at least where the survivor's prior
claim was finally decided by a United States Court of Appeals. The
commenter relies on Plaut v. Spendthrift Farm, Inc., 514 U.S. 211
(1995) in support. Striking down a Security and Exchange Act statutory
amendment that allowed plaintiffs to reinstate certain suits that had
already been finally dismissed as time-barred, Plaut held that Article
III of the Constitution established a ``judicial department,'' with
``the power, not merely to rule on cases, but to decide them, subject
to review only by superior courts . . .--with an understanding . . .
that a `judgment conclusively resolves the case' because `[the
judiciary] render[s] dispositive judgments.' '' 514 U.S. at 218-19
(quoting Easterbrook, Presidential Review, 40 Case W. Res. L. Rev. 905,
926 (1990)).
Plaut and the separation-of-powers principle have no relevance with
respect to ACA Section 1556 and proposed Sec. 725.309. Unlike the
statute at issue in Plaut, Section 1556 and the rule implementing it do
not require the reopening of final judicial decisions. Rather, Section
1556 changed the underlying substantive law, thereby creating a new
cause of action that applies only to claims pending on or after its
enactment date (March 23, 2010). See, e.g., In re Swanson, 540 F.3d
1368, 1378-79 (Fed. Cir. 2008) (rejecting separation-of-powers
challenge to reexamination of patent previously upheld by court, as two
examinations were ``differing proceedings with different evidentiary
standards''). Far from allowing a legislative veto of a prior judicial
determination, Section 1556 and the proposed rule give ``full credit''
to prior claim denial. Buck Creek Coal Co. v. Sexton, 706 F.3d 756,
759-60 (6th Cir. 2013) (quoting U.S. Steel Mining Co., LLC, v.
Director, OWCP, 386 F.3d 977, 990 (11th Cir. 2004)). The rules
governing the date from which benefits are payable--including those
payable on subsequent survivor claims--evidence this principle because
no benefits are payable ``for any period prior to the date upon which
the order denying the prior claim became final.'' 20 CFR 725.309(d)(5)
(2012).
(c) No other comments on this section were received and the
Department has promulgated the rule as proposed.
IV. Information Collection Requirements (Subject to the Paperwork
Reduction Act) Imposed Under the Proposed Rule
This rulemaking imposes no new collections of information.
V. Executive Orders 12866 and 13563 (Regulatory Planning and Review)
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, if
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety effects, distributive impacts, and equity). E.O.
13563 emphasizes the importance of quantifying both costs and benefits,
of reducing costs, of harmonizing rules, and of promoting flexibility.
It also instructs agencies to review ``rules that may be outmoded,
ineffective, insufficient, or excessively burdensome, and to modify,
streamline, expand, or repeal them.'' In accordance with this Executive
Order, the Department has proposed certain changes to these rules not
otherwise required to implement the ACA's statutory amendments.
These final rules are consistent with the statutory mandate,
reflecting the policy choices made by Congress in adopting the ACA
amendments. Those choices reflect Congress' rational decision ``to
spread the costs of the employees' disabilities to those who have
profited from the fruits of their labor--the operators and the coal
consumers.'' Stacy, 671 F.3d at 383 (quoting Usery, 428 U.S. at 18)).
In restoring Section 411(c)(4), ``Congress decided to ease the path to
recovery for claimants who could prove at least 15 years of coal mine
employment and a totally disabling pulmonary impairment,'' thus giving
miners and their survivors ``a better shot at obtaining benefits.''
Keene v. Consolidation Coal Co., 645 F.3d 844, 849 (7th Cir. 2011). And
in restoring Section 422(l), Congress made ``a legislative choice to
compensate a miner's dependents for the suffering they endured due to
the miner's pneumoconiosis or as a means to provide a miner with peace
of mind that his dependents will continue to receive benefits after his
death.'' Campbell, 662 F.3d at 258. The rules faithfully implement
these Congressional directives.
Although additional expenditures associated with these rules
primarily flow from the statutory amendments themselves rather than the
rules, the Department has evaluated the financial impact of the
amendments' application on coal mine operators, and in particular those
classified as small businesses, as set forth in the NPRM. See 77 FR at
19470-74. Coal mine operators' outlays for the workers' compensation
insurance necessary to secure the payment of any benefits resulting
from the amendments will likely increase, at least in the short run.
Self-insured operators may also be required to pay out more in
compensation to entitled miners and survivors.
These operator expenditures are transfer payments as defined by OMB
Circular A-4 (i.e., payments from one group to another that do not
affect the total resources available to society). To
[[Page 59112]]
estimate additional workers' compensation insurance premiums that may
result from the ACA amendments, the Department projected new claim
filings, award rates and associated insurance premiums both with and
without the amendments for the ten-year period 2010 through 2019. Based
on the projected differences, the Department estimates that annualized
industry insurance premiums will increase $35 million over this ten-
year period as a result of the ACA amendments. This figure likely
overstates the premium increase because it is based on two important
assumptions designed to consider a maximum-impact scenario: The
estimates assume that all coal mine operators purchase commercial
workers' compensation insurance rather than self-insuring, and the
insurance rates used are based on the higher rates charged by assigned-
risk plans rather than the lower rates generally available in the
voluntary market. The Department's estimate is explained more fully in
the Regulatory Flexibility Act discussion below.
Transfers also occur between insurance carriers or self-insured
coal mine operators and benefit recipients. These transfers take the
form of benefit payments. The amount of benefits payable on any given
award depends upon a variety of factors, including the benefit
recipient's identity, the length of the recipient's life, and whether
the recipient has any eligible dependents for whom the basic benefit
amount may be augmented. See generally 20 CFR 725.202-725.228; 725.520
(2012).
For example, in FY 2010, the Department oversaw 28,671 active Part
C BLBA claims with income and medical benefit disbursements of
approximately $238 million. This translates into an annual benefit rate
of $8,316 per claim, or an average monthly benefit of $693. Of the
total active claims in 2010 payable by coal mine operators and their
insurance carriers, an estimated 156 were new awards resulting from the
ACA amendments, translating into approximately $1.3 million in
additional income and medical benefit disbursements in the first year.
Accordingly, the Department's predicted 425 new awards in responsible
operator claims for 2011 equates to an estimated $3.5 million increase
in benefit disbursements for the first year.
Payments from the Black Lung Disability Trust Fund will also
increase due to a small number of claims awarded under the ACA
amendments and for which no coal mine operator may be held liable. The
Department estimates that Trust Fund benefit payments will increase a
total of approximately $48.3 million over the 10-year period from 2010-
2019. Despite this amendment-related increase, Trust Fund benefit
payments as a whole are decreasing annually. The majority of the Trust
Fund's liabilities stem from earlier days of the black lung program,
when the Trust Fund bore liability for a much higher percentage of
awarded claims. Trust Fund payments cease when these benefit recipients
pass away. As a result, the Trust Fund's expenditures continue to
decrease each year.
Claimants who obtain benefits under the ACA amendments will gain a
variety of advantages that are difficult to quantify in monetary terms.
A disabled miner ``has suffered in at least two ways: His health is
impaired, and he has been rendered unable to perform the kind of work
to which he has adapted himself.'' Usery, 428 U.S. at 21. Income
disbursements give these miners some financial relief and provide a
modicum of compensation for the health impairment the miners suffered
in working to meet the Nation's energy needs. Medical treatment
benefits provide health care to miners for the injury caused by their
occupationally acquired pulmonary diseases and disabilities so as to
maximize both their longevity and quality of life. Both income and
medical benefits alleviate drains on public assistance resources. And
miners awarded benefits under the ACA amendments may also rest assured
that their dependent survivors will not be left wholly without
financial support.
In exchange, coal mine operators continue to be protected from
common law tort actions that could otherwise be brought by these miners
or their survivors for pneumoconiosis arising from the miner's
employment and related disabilities or death. See 33 U.S.C. 905(a),
incorporated by 30 U.S.C. 932(a). And because the monthly benefit
amounts payable are fixed by statute, compensation costs are
predictable and feasible for insurers to cover at an affordable rate.
This predictability also allows coal mine operators to pass their costs
for insurance (or benefits if self-insured) on to consumers.
From a program-administration viewpoint, the Department will
realize some cost savings from the ACA amendment restoring Section
422(l)'s automatic entitlement for survivors. Before the amendment, the
Department had to develop each survivor's claim, including obtaining
relevant medical evidence, evaluating that evidence, and issuing a
detailed decision adjudicating whether the miner's death was due to
pneumoconiosis. That administrative work, and the costs associated with
it, is no longer necessary where the survivor is entitled under Section
422(l). Instead, the regulations adopt a streamlined process for those
cases that eliminates most evidentiary development and evaluation. This
process has the dual benefit of delivering compensation to entitled
survivors more quickly and reducing the costs associated with that
delivery.
The Department received only two comments on its economic analysis
of the impact of the ACA amendments and the proposed rules. The
Department's response to those two comments is included in the
Regulatory Flexibility Act section below.
The Office of Information and Regulatory Affairs of the Office of
Management and Budget has determined that the Department's rule
represents a ``significant regulatory action'' under Section 3(f)(4) of
Executive Order 12866 and has reviewed the rule.
VI. Small Business Regulatory Enforcement Fairness Act of 1996
As required by Congress under the Small Business Regulatory
Enforcement Fairness Act of 1996, enacted as Title II of Public Law
104-121, 201-253, 110 Stat. 847, 857 (1996), the Department will report
promulgation of this rule to both Houses of the Congress and to the
Comptroller General prior to its effective date. The report will state
that the rule is not a ``major rule'' as defined under 5 U.S.C. 804(2).
VII. Unfunded Mandates Reform Act of 1995
Title II of the Unfunded Mandates Reform Act of 1995, 2 U.S.C. 1531
et seq., directs agencies to assess the effects of Federal Regulatory
Actions on State, local, and tribal governments, and the private
sector, ``other than to the extent that such regulations incorporate
requirements specifically set forth in law.'' 2 U.S.C. 1531. For
purposes of the Unfunded Mandates Reform Act, this rule does not
include any Federal mandate that may result in increased expenditures
by State, local, tribal governments, or increased expenditures by the
private sector of more than $100,000,000.
VIII. Regulatory Flexibility Act and Executive Order 13272 (Proper
Consideration of Small Entities in Agency Rulemaking)
The Regulatory Flexibility Act of 1980, as amended, 5 U.S.C. 601 et
seq., (RFA), requires an agency to prepare an initial regulatory
flexibility analysis describing the proposed rule's impact
[[Page 59113]]
on small entities. 5 U.S.C. 603. The RFA also requires agencies to
prepare a final regulatory flexibility analysis when promulgating the
final rule. 5 U.S.C. 604. In either instance, the RFA does not require
a regulatory flexibility analysis if the agency certifies that the
proposed or final rule will not have ``a significant economic impact on
a substantial number of small entities'' and provides the factual basis
for the certification. 5 U.S.C. 605. The Department has determined that
a final regulatory flexibility analysis is not required for this
rulemaking.
The Department conducted an initial regulatory flexibility analysis
(IRFA) prior to publishing the proposed rule, informed the public how
to obtain a copy of the complete analysis, summarized the analysis in
the preamble to the proposed rule, and asked for public comment on all
aspects of the costs and benefits of the proposed rule, particularly
with respect to impacts on small businesses. 77 FR at 19471-74. The
Department surveyed the industry and determined that virtually all coal
mine operators in the United States fall within the Small Business
Administration's definition of a small business. 77 FR at 19471-72.
Even though the statutory amendments themselves, rather than the rules
implementing them, account for most, if not all, of the additional
costs imposed on the coal mining industry, the Department estimated the
maximum financial impact that might result from the amendments and
rules by evaluating potential increased costs to purchase workers'
compensation insurance. See 30 U.S.C. 933 (requiring all coal mine
operators to either purchase commercial workers' compensation insurance
or qualify as a self-insurer to insure covered workers). The Department
determined that the ACA amendments and the implementing rules would
impose an annualized cost on the industry of $35 million--or only one-
tenth of one percent of average annual industry revenues--over the ten
years from 2010 to 2019, with decreasing costs thereafter. 77 FR at
19473. The Department noted that these estimates likely overstated the
actual cost impact and were transitory in nature. 77 FR at 19471-73.
One comment generally states that the Department's economic
analysis is opaque, unsupported by data or analysis, and lacks source
citations for such data and analysis necessary to allow it to
adequately review the Department's conclusions. The comment also
believes the Department's analysis was overly dismissive given the
prospect of reopening thousands of previously denied survivors' claims
and allowing re-filing of an unknown number of denied miners' claims.
Another comment questions how the Department calculated the number of
survivors (and the resulting benefits payable) who would be
automatically entitled to benefits under amended Section 422(l). This
comment was made in the context of the Department's construction of
subsequent survivor claims.
The Department believes its economic analysis was complete. The
Department prepared a fully documented and explained IRFA that cited
both internal and external data sources, and made the IRFA available to
the public through the internet and by individual request. 77 FR at
19471. One comment grossly overstates the potential impact of
subsequent survivors' claims liability on the costs associated with the
amendments and the rule. In the NPRM, the Department estimated that out
of a pool of 445 potential survivors in this category, only 317 might
file subsequent claims to assert entitlement under amended Section
422(l). 77 FR at 19473-74. Actual experience has shown that number to
be far lower. To date, only 143 survivors have filed subsequent claims
seeking benefits under amended Section 422(l).
Moreover, as the Department noted in the NPRM, the financial impact
of revised Sec. 725.309 on coal mine operators is mitigated in two
ways. 77 at FR 19474. First, the survivors in question would not be
entitled to benefits for the period prior to the day on which the prior
denial became final. Second, an operator who ensures its BLBA
liabilities with commercial insurance will not incur any additional
costs because it has already purchased the insurance necessary to cover
the survivor's claim. For these reasons, the Department does not
believe that allowing re-filing survivors to receive benefits under
amended Section 422(l) imposes significant hardships on small coal mine
businesses.
Significantly, no commenter or interested small business brought
forth any information that contradicts the Department's conclusions in
the IRFA, despite the Department's specific request for comments about
adverse effects on small businesses. For instance, no one submitted
documentation detailing actual experience with either increased
workers' compensation insurance premium rates or self-insurance
expenses since enactment of the ACA amendments in 2010. Nor did any
comment allege that such increases have occurred. The Department
therefore has no reason to conclude that its cost estimates set forth
in the IRFA are understated or that these businesses will incur
significant adverse financial impacts.
Thus, although most coal mine operators are small businesses, the
Department does not believe that an estimated annualized cost imposed
for complying with the ACA amendments, as implemented by these
regulations, amounting to at most one-tenth of one percent of industry
revenues is a significant economic impact. The Department therefore
certifies that this final rule will not have significant economic
impact on a substantial number of small entities. Accordingly, it has
not prepared a final regulatory impact analysis. The Department has
provided the Chief Counsel for Advocacy of the Small Business
Administration with a copy of this certification. See 5 U.S.C. 605.
IX. Executive Order 13132 (Federalism)
The Department has reviewed this final rule in accordance with
Executive Order 13132 regarding federalism, and has determined that it
does not have ``federalism implications.'' E.O. 13132, 64 FR 43255
(Aug. 4, 1999). The final rule will not ``have substantial direct
effects on the States, on the relationship between the national
government and the States, or on the distribution of power and
responsibilities among the various levels of government.'' Id.
X. Executive Order 12988 (Civil Justice Reform)
The final rule meets the applicable standards in Sections 3(a) and
3(b)(2) of Executive Order 12988, Civil Justice Reform, to minimize
litigation, eliminate ambiguity, and reduce burden.
XI. Congressional Review Act
The final rule is not a ``major rule'' as defined in the
Congressional Review Act, 5 U.S.C. 801 et seq. This rule will not
result in an annual effect on the economy of $100,000,000 or more; a
major increase in costs or prices for consumers, individual industries,
Federal, State or local government agencies, or geographic regions; or
significant adverse effects on competition, employment, investment,
productivity, innovation, or on the ability of United States-based
enterprises to compete with foreign-based enterprises in domestic and
export markets.
[[Page 59114]]
List of Subjects in 20 CFR Parts 718 and 725
Total Disability due to pneumoconiosis; coal miners' entitlement to
benefits; survivors' entitlement to benefits.
For the reasons set forth in the preamble, the Department of Labor
amends 20 CFR parts 718 and 725 as follows:
PART 718--STANDARDS FOR DETERMINING COAL MINERS' TOTAL DISABILITY
OR DEATH DUE TO PNEUMOCONIOSIS
0
1. The authority citation for part 718 is revised to read as follows:
Authority: 5 U.S.C. 301; Reorganization Plan No. 6 of 1950, 15
FR 3174; 30 U.S.C. 901 et seq., 902(f), 934, 936; 33 U.S.C. 901 et
seq.; 42 U.S.C. 405; Secretary's Order 10-2009, 74 FR 58834.
0
2. Revise Sec. 718.1 to read as follows:
Sec. 718.1 Statutory provisions.
Section 402(f) of the Act authorizes the Secretary of Labor to
establish criteria for determining total disability or death due to
pneumoconiosis to be applied in the processing and adjudication of
claims filed under Part C of the Act. Section 402(f) further authorizes
the Secretary of Labor, in consultation with the National Institute for
Occupational Safety and Health, to establish criteria for all
appropriate medical tests administered in connection with a claim for
benefits. Section 413(b) of the Act authorizes the Secretary of Labor
to establish criteria for the techniques used to take chest
roentgenograms (x-rays) in connection with a claim for benefits under
the Act.
0
3. Revise Sec. 718.2 to read as follows:
Sec. 718.2 Applicability of this part.
(a) With the exception of the second sentence of Sec. 718.204(a),
this part is applicable to the adjudication of all claims filed on or
after June 30, 1982 under Part C of the Act. It provides standards for
establishing entitlement to benefits under the Act and describes the
criteria for the development of medical evidence used in establishing
such entitlement. The second sentence of Sec. 718.204(a) is applicable
to the adjudication of all claims filed after January 19, 2001.
(b) Publication of certain provisions or parts of certain
provisions that apply only to claims filed prior to June 30, 1982, or
to claims subject to Section 435 of the Act, has been discontinued
because those provisions affect an increasingly smaller number of
claims. The version of Part 718 set forth in 20 CFR, parts 500 to end,
edition revised as of April 1, 2010, applies to the adjudication of all
claims filed prior to June 30, 1982, as appropriate.
(c) The provisions of this part must, to the extent appropriate, be
construed together in the adjudication of claims.
0
4. In Sec. 718.3, revise paragraph (a) to read as follows:
Sec. 718.3 Scope and intent of this part.
(a) This part sets forth the standards to be applied in determining
whether a coal miner is or was totally disabled due to pneumoconiosis
or died due to pneumoconiosis. It also specifies the procedures and
requirements to be followed in conducting medical examinations and in
administering various tests relevant to such determinations.
* * * * *
0
5. In Sec. 718.202, revise paragraph (a)(3) to read as follows:
Sec. 718.202 Determining the existence of pneumoconiosis.
(a) * * *
(3) If the presumptions described in Sec. 718.304 or Sec. 718.305
are applicable, it must be presumed that the miner is or was suffering
from pneumoconiosis.
* * * * *
0
6. Revise Sec. 718.205 to read as follows:
Sec. 718.205 Death due to pneumoconiosis.
(a) Benefits are provided to eligible survivors of a miner whose
death was due to pneumoconiosis. In order to receive benefits based on
a showing of death due to pneumoconiosis, a claimant must prove that:
(1) The miner had pneumoconiosis (see Sec. 718.202);
(2) The miner's pneumoconiosis arose out of coal mine employment
(see Sec. 718.203); and
(3) The miner's death was due to pneumoconiosis as provided by this
section.
(b) Death will be considered to be due to pneumoconiosis if any of
the following criteria is met:
(1) Where competent medical evidence establishes that
pneumoconiosis was the cause of the miner's death, or
(2) Where pneumoconiosis was a substantially contributing cause or
factor leading to the miner's death or where the death was caused by
complications of pneumoconiosis, or
(3) Where the presumption set forth at Sec. 718.304 is applicable,
or
(4) For survivors' claims filed after January 1, 2005, and pending
on or after March 23, 2010, where the presumption at Sec. 718.305 is
invoked and not rebutted.
(5) However, except where the Sec. 718.304 presumption is invoked,
survivors are not eligible for benefits where the miner's death was
caused by a traumatic injury (including suicide) or the principal cause
of death was a medical condition not related to pneumoconiosis, unless
the claimant establishes (by proof or presumption) that pneumoconiosis
was a substantially contributing cause of death.
(6) Pneumoconiosis is a ``substantially contributing cause'' of a
miner's death if it hastens the miner's death.
0
7. Revise Sec. 718.301 to read as follows:
Sec. 718.301 Establishing length of employment as a miner.
The presumptions set forth in Sec. Sec. 718.302 and 718.305 apply
only if a miner worked in one or more coal mines for the number of
years required to invoke the presumption. The length of the miner's
coal mine work history must be computed as provided by 20 CFR
725.101(a)(32).
Sec. 718.303 [Removed and Reserved]
0
8. Remove and reserve Sec. 718.303.
0
9. Revise Sec. 718.305 to read as follows:
Sec. 718.305 Presumption of pneumoconiosis.
(a) Applicability. This section applies to all claims filed after
January 1, 2005, and pending on or after March 23, 2010.
(b) Invocation. (1) The claimant may invoke the presumption by
establishing that--
(i) The miner engaged in coal-mine employment for fifteen years,
either in one or more underground coal mines, or in coal mines other
than underground mines in conditions substantially similar to those in
underground mines, or in any combination thereof; and
(ii) The miner or survivor cannot establish entitlement under Sec.
718.304 by means of chest x-ray evidence; and
(iii) The miner has, or had at the time of his death, a totally
disabling respiratory or pulmonary impairment established pursuant to
Sec. 718.204, except that Sec. 718.204(d) does not apply.
(2) The conditions in a mine other than an underground mine will be
considered ``substantially similar'' to those in an underground mine if
the claimant demonstrates that the miner was regularly exposed to coal-
mine dust while working there.
(3) In a claim involving a living miner, a miner's affidavit or
testimony, or a spouse's affidavit or testimony, may not be used by
itself to establish the existence of a totally disabling respiratory or
pulmonary impairment.
(4) In the case of a deceased miner, affidavits (or equivalent
sworn
[[Page 59115]]
testimony) from persons knowledgeable of the miner's physical condition
must be considered sufficient to establish total disability due to a
respiratory or pulmonary impairment if no medical or other relevant
evidence exists which addresses the miner's pulmonary or respiratory
condition; however, such a determination must not be based solely upon
the affidavits or testimony of any person who would be eligible for
benefits (including augmented benefits) if the claim were approved.
(c) Facts presumed. Once invoked, there will be rebuttable
presumption--
(1) In a miner's claim, that the miner is totally disabled due to
pneumoconiosis, or was totally disabled due to pneumoconiosis at the
time of death; or
(2) In a survivor's claim, that the miner's death was due to
pneumoconiosis.
(d) Rebuttal--(1) Miner's claim. In a claim filed by a miner, the
party opposing entitlement may rebut the presumption by--
(i) Establishing both that the miner does not, or did not, have:
(A) Legal pneumoconiosis as defined in Sec. 718.201(a)(2); and
(B) Clinical pneumoconiosis as defined in Sec. 718.201(a)(1),
arising out of coal mine employment (see Sec. 718.203); or
(ii) Establishing that no part of the miner's respiratory or
pulmonary total disability was caused by pneumoconiosis as defined in
Sec. 718.201.
(2) Survivor's claim. In a claim filed by a survivor, the party
opposing entitlement may rebut the presumption by--
(i) Establishing both that the miner did not have:
(A) Legal pneumoconiosis as defined in Sec. 718.201(a)(2); and
(B) Clinical pneumoconiosis as defined in Sec. 718.201(a)(1),
arising out of coal mine employment (see Sec. 718.203); or
(ii) Establishing that no part of the miner's death was caused by
pneumoconiosis as defined in Sec. 718.201.
(3) The presumption must not be considered rebutted on the basis of
evidence demonstrating the existence of a totally disabling obstructive
respiratory or pulmonary disease of unknown origin.
Sec. 718.306 [Removed and Reserved]
0
10. Remove and reserve Sec. 718.306.
0
11. Revise the introductory text of Appendix C to Part 718 to read as
follows:
Appendix C to Part 718--Blood-Gas Tables
The following tables set forth the values to be applied in
determining whether total disability may be established in
accordance with Sec. 718.204(b)(2)(ii). The values contained in the
tables are indicative of impairment only. They do not establish a
degree of disability except as provided in Sec. 718.204(b)(2)(ii)
of this subchapter, nor do they establish standards for determining
normal alveolar gas exchange values for any particular individual.
Tests must not be performed during or soon after an acute
respiratory or cardiac illness. A miner who meets the following
medical specifications must be found to be totally disabled, in the
absence of rebutting evidence, if the values specified in one of the
following tables are met:
* * * * *
PART 725--CLAIMS FOR BENEFITS UNDER PART C OF TITLE IV OF THE
FEDERAL MINE SAFETY AND HEALTH ACT, AS AMENDED
0
12. The authority citation for part 725 continues to read as follows:
Authority: 5 U.S.C. 301; Reorganization Plan No. 6 of 1950, 15
FR 3174; 30 U.S.C. 901 et seq., 902(f), 921, 932, 936; 33 U.S.C. 901
et seq.; 42 U.S.C. 405; Secretary's Order 10-2009, 74 FR 58834.
0
13. Revise Sec. 725.1 to read as follows:
Sec. 725.1 Statutory provisions.
(a) General. Subchapter IV of the Federal Coal Mine Health and
Safety Act of 1969, as amended by the Black Lung Benefits Act of 1972,
the Federal Mine Safety and Health Amendments Act of 1977, the Black
Lung Benefits Reform Act of 1977, the Black Lung Benefits Revenue Act
of 1977, the Black Lung Benefits Amendments of 1981, the Black Lung
Benefits Revenue Act of 1981, the Black Lung Consolidation of
Responsibility Act of 2002, and the Patient Protection and Affordable
Care Act of 2010 (together comprising the Black Lung Benefits Act (see
Sec. 725.101(a)(1)) provides for the payment of benefits to certain
disabled coal miners and their survivors. See Sec. 725.201.
(b) Part B. Part B of subchapter IV of the Act provided that claims
filed before July 1, 1973 were to be filed with, and adjudicated and
administered by, the Social Security Administration (SSA). If awarded,
these claims were paid by SSA out of appropriated funds. The Black Lung
Consolidation of Administrative Responsibility Act (see paragraph (h)
of this section) transferred all responsibility for continued
administration of these claims to the Department of Labor.
(c) Part C. Claims filed by a miner or survivor on or after January
1, 1974, are filed, adjudicated, and paid under the provisions of part
C of subchapter IV of the Act. Part C requires that a claim filed on or
after January 1, 1974, shall be filed under an applicable approved
State workers' compensation law, or if no such law has been approved by
the Secretary of Labor, the claim may be filed with the Secretary of
Labor under Section 422 of the Act. Claims filed with the Secretary of
Labor under part C are processed and adjudicated by the Secretary.
Individual coal mine operators are primarily liable for benefits;
however, if the miner's last coal mine employment terminated before
January 1, 1970, or if no responsible operator can be identified,
benefits are paid by the Black Lung Disability Trust Fund. Claims
adjudicated under part C are subject to certain incorporated provisions
of the Longshore and Harbor Workers' Compensation Act.
(d) Changes made by the Black Lung Benefits Reform Act of 1977. The
Black Lung Benefits Reform Act of 1977 contains a number of significant
amendments to the Act's standards for determining eligibility for
benefits. Among these are:
(1) A provision which clarifies the definition of
``pneumoconiosis'' to include any ``chronic dust disease of the lung
and its sequelae, including respiratory and pulmonary impairments,
arising out of coal mine employment'';
(2) A provision which defines ``miner'' to include any person who
works or has worked in or around a coal mine or coal preparation
facility, and in coal mine construction or coal transportation under
certain circumstances;
(3) A provision that continued employment in a coal mine is not
conclusive proof that a miner is not or was not totally disabled;
(4) A provision which authorizes the Secretary of Labor to
establish standards and develop criteria for determining total
disability or death due to pneumoconiosis with respect to a part C
claim;
(5) Provisions relating to the treatment to be accorded a
survivor's affidavit, certain X-ray interpretations, and certain
autopsy reports in the development of a claim; and
(6) Other clarifying, procedural, and technical amendments.
(e) Changes made by the Black Lung Benefits Revenue Act of 1977.
The Black Lung Benefits Revenue Act of 1977 established the Black Lung
Disability Trust Fund which is financed by a
[[Page 59116]]
specified tax imposed upon each ton of coal (except lignite) produced
and sold or used in the United States after March 31, 1978. The
Secretary of the Treasury is the managing trustee of the fund and
benefits are paid from the fund upon the direction of the Secretary of
Labor. The fund was made liable for the payment of all claims approved
under part C of the Act for all periods of eligibility occurring on or
after January 1, 1974, with respect to claims where the miner's last
coal mine employment terminated before January 1, 1970, or where
individual liability can not be assessed against a coal mine operator
due to bankruptcy, insolvency, or the like. The fund was also
authorized to pay certain claims which a responsible operator has
refused to pay within a reasonable time, and to seek reimbursement from
such operator. The purpose of the fund and the Black Lung Benefits
Revenue Act of 1977 was to insure that coal mine operators, or the coal
industry, will fully bear the cost of black lung disease for the
present time and in the future. The Black Lung Benefits Revenue Act of
1977 also contained other provisions relating to the fund and
authorized a coal mine operator to establish its own trust fund for the
payment of certain claims.
(f) Changes made by the Black Lung Benefits Amendments of 1981. The
Black Lung Benefits Amendments of 1981 made a number of significant
changes in the Act's standards for determining eligibility for benefits
and concerning the payment of such benefits, and applied the changes to
claims filed on or after January 1, 1982. Among these are:
(1) The Secretary of Labor may re-read any X-ray submitted in
support of a claim and may rely upon a second opinion concerning such
an X-ray as a means of auditing the validity of the claim;
(2) The rebuttable presumption that the total disability of a miner
with fifteen or more years employment in the coal mines, who has
demonstrated a totally disabling respiratory or pulmonary impairment,
is due to pneumoconiosis is no longer applicable (but the presumption
was reinstated for claims filed after January 1, 2005, and pending on
or after March 23, 2010, by the Patient Protection and Affordable Care
Act of 2010 (see paragraph (i) of this section));
(3) In the case of deceased miners, where no medical or other
relevant evidence is available, only affidavits from persons not
eligible to receive benefits as a result of the adjudication of the
claim will be considered sufficient to establish entitlement to
benefits;
(4) Unless the miner was found entitled to benefits as a result of
a claim filed prior to January 1, 1982, benefits are payable on
survivors' claims filed on and after January 1, 1982, only when the
miner's death was due to pneumoconiosis (but for survivors' claims
filed after January 1, 2005, and pending on or after March 23, 2010, an
award of a miner's claim may form the basis for a survivor's
entitlement under the Patient Protection and Affordable Care Act of
2010 (see paragraph (i) of this section));
(5) Benefits payable under this part are subject to an offset on
account of excess earnings by the miner; and
(6) Other technical amendments.
(g) Changes made by the Black Lung Benefits Revenue Act of 1981.
The Black Lung Benefits Revenue Act of 1981 temporarily doubles the
amount of the tax upon coal until the fund has repaid all advances
received from the United States Treasury and the interest on all such
advances. With respect to claims filed on or after January 1, 1982, the
fund's authorization for the payment of interim benefits is limited to
the payment of prospective benefits only. These changes also define the
rates of interest to be paid to and by the fund.
(h) Changes made by the Black Lung Consolidation of Administrative
Responsibility Act. The Black Lung Consolidation of Administrative
Responsibility Act of 2002 transferred administrative responsibility
for all claims previously filed with or administered by the Social
Security Administration to the Department of Labor, effective January
31, 2003. As a result, certain obsolete provisions in the BLBA (30
U.S.C. 904, 924a, and 945) were repealed. Various technical changes
were made to other statutory provisions.
(i) Changes made by the Patient Protection and Affordable Care Act
of 2010. The Patient Protection and Affordable Care Act of 2010 (the
ACA) changed the entitlement criteria for miners' and survivors' claims
filed after January 1, 2005, and pending on or after March 23, 2010, by
reinstating two provisions made inapplicable by the Black Lung Benefits
Amendments of 1981.
(1) For miners' claims meeting these date requirements, the ACA
reinstated the rebuttable presumption that the miner is (or was)
totally disabled due to pneumoconiosis if the miner has (or had) 15 or
more years of qualifying coal mine employment and a totally disabling
respiratory or pulmonary impairment.
(2) For survivors' claims meeting these date requirements, the ACA
made two changes. First, it reinstated the rebuttable presumption that
the miner's death was due to pneumoconiosis if the miner had 15 years
or more of qualifying coal mine employment and was totally disabled by
a respiratory or pulmonary impairment at the time of death. Second, it
reinstituted derivative survivors' entitlement. As a result, an
eligible survivor will be entitled to benefits if the miner is or was
found entitled to benefits on his or her lifetime claim based on total
disability due to pneumoconiosis arising out of coal-mine employment.
(j) Longshore Act provisions. The adjudication of claims filed
under part C of the Act (i.e., claims filed on or after January 1,
1974) is governed by various procedural and other provisions contained
in the Longshore and Harbor Workers' Compensation Act (LHWCA), as
amended from time to time, which are incorporated within the Act by
section 422. The incorporated LHWCA provisions are applicable under the
Act except as is otherwise provided by the Act or as provided by
regulations of the Secretary. Although occupational disease benefits
are also payable under the LHWCA, the primary focus of the procedures
set forth in that Act is upon a time-definite-traumatic injury or
death. Because of this and other significant differences between a
black lung and longshore claim, it is determined, in accordance with
the authority set forth in Section 422 of the Act, that certain of the
incorporated procedures prescribed by the LHWCA must be altered to fit
the circumstances ordinarily confronted in the adjudication of a black
lung claim. The changes made are based upon the Department's experience
in processing black lung claims since July 1, 1973, and all such
changes are specified in this part. No other departure from the
incorporated provisions of the LHWCA is intended.
(k) Social Security Act provisions. Section 402 of Part A of the
Act incorporates certain definitional provisions from the Social
Security Act, 42 U.S.C. 301 et seq. Section 430 provides that the 1972,
1977 and 1981 amendments to part B of the Act shall also apply to part
C ``to the extent appropriate.'' Sections 412 and 413 incorporate
various provisions of the Social Security Act into part B of the Act.
To the extent appropriate, therefore, these provisions also apply to
part C. In certain cases, the Department has varied the terms of the
Social Security Act provisions to accommodate the unique needs of the
black lung
[[Page 59117]]
benefits program. Parts of the Longshore and Harbor Workers'
Compensation Act are also incorporated into part C. Where the
incorporated provisions of the two acts are inconsistent, the
Department has exercised its broad regulatory powers to choose the
extent to which each incorporation is appropriate. Finally, Section
422(g), contained in part C of the Act, incorporates 42 U.S.C. 403(b)-
(l).
0
14. Revise Sec. 725.2 to read as follows:
Sec. 725.2 Purpose and applicability of this part.
(a) This part sets forth the procedures to be followed and
standards to be applied in filing, processing, adjudicating, and paying
claims filed under part C of subchapter IV of the Act.
(b) This part applies to all claims filed under part C of
subchapter IV of the Act on or after June 30, 1982. Publication of
certain provisions or parts of certain provisions that apply only to
claims filed prior to June 30, 1982, or to claims subject to Section
435 of the Act, has been discontinued because those provisions affect
an increasingly smaller number of claims. The version of Part 725 set
forth in 20 CFR, parts 500 to end, edition revised as of April 1, 2010,
applies to the adjudication of all claims filed prior to June 30, 1982,
as appropriate.
(c) The provisions of this part reflect revisions that became
effective on January 19, 2001. This part applies to all claims filed
after January 19, 2001 and all benefits payments made on such claims.
With the exception of the following sections, this part also applies to
the adjudication of claims that were pending on January 19, 2001 and
all benefits payments made on such claims: Sec. Sec. 725.101(a)(31),
725.204, 725.212(b), 725.213(c), 725.214(d), 725.219(d), 725.309,
725.310, 725.351, 725.360, 725.367, 725.406, 725.407, 725.408, 725.409,
725.410, 725.411, 725.412, 725.414, 725.415, 725.416, 725.417, 725.418,
725.421(b), 725.423, 725.454, 725.456, 725.457, 725.458, 725.459,
725.465, 725.491, 725.492, 725.493, 725.494, 725.495, 725.547,
725.701(e). The version of those sections set forth in 20 CFR, parts
500 to end, edition revised as of April 1, 1999, apply to the
adjudications of claims that were pending on January 19, 2001. For
purposes of construing the provisions of this section, a claim will be
considered pending on January 19, 2001 if it was not finally denied
more than one year prior to that date.
0
15. In Sec. 725.101, revise paragraphs (a)(1), (a)(2), (a)(4),
(a)(32)(i) through (iv), and (b) to read as follows:
Sec. 725.101 Definition and use of terms.
(a) * * *
(1) The Act means the Black Lung Benefits Act, 30 U.S.C. 901-44, as
amended.
(2) The Longshore Act or LHWCA means the Longshore and Harbor
Workers' Compensation Act, 33 U.S.C. 901-950, as amended from time to
time.
* * * * *
(4) Administrative law judge means a person qualified under 5
U.S.C. 3105 to conduct hearings and adjudicate claims for benefits
filed pursuant to section 415 and part C of the Act. Until March 1,
1979, it also means an individual appointed to conduct such hearings
and adjudicate such claims under Public Law 94-504.
* * * * *
(32) * * *
(i) If the evidence establishes that the miner worked in or around
coal mines at least 125 working days during a calendar year or partial
periods totaling one year, then the miner has worked one year in coal
mine employment for all purposes under the Act. If a miner worked fewer
than 125 working days in a year, he or she has worked a fractional year
based on the ratio of the actual number of days worked to 125. Proof
that the miner worked more than 125 working days in a calendar year or
partial periods totaling a year, does not establish more than one year.
(ii) To the extent the evidence permits, the beginning and ending
dates of all periods of coal mine employment must be ascertained. The
dates and length of employment may be established by any credible
evidence including (but not limited to) company records, pension
records, earnings statements, coworker affidavits, and sworn testimony.
If the evidence establishes that the miner's employment lasted for a
calendar year or partial periods totaling a 365-day period amounting to
one year, it must be presumed, in the absence of evidence to the
contrary, that the miner spent at least 125 working days in such
employment.
(iii) If the evidence is insufficient to establish the beginning
and ending dates of the miner's coal mine employment, or the miner's
employment lasted less than a calendar year, then the adjudication
officer may use the following formula: divide the miner's yearly income
from work as a miner by the coal mine industry's average daily earnings
for that year, as reported by the Bureau of Labor Statistics (BLS). A
copy of the BLS table must be made a part of the record if the
adjudication officer uses this method to establish the length of the
miner's work history.
(iv) Periods of coal mine employment occurring outside the United
States must not be considered in computing the miner's work history.
(b) Statutory terms. The definitions contained in this section must
not be construed in derogation of terms of the Act.
* * * * *
0
16. In Sec. 725.201:
0
a. Revise paragraph (a);
0
b. Remove paragraph (b); and
0
c. Redesignate paragraphs (c) and (d) as paragraphs (b) and (c).
The revision reads as follows:
Sec. 725.201 Who is entitled to benefits; contents of this subpart.
(a) Part C of the Act provides for the payment of periodic benefits
in accordance with this part to:
(1) A miner who meets the conditions of entitlement set forth in
Sec. 725.202(d); or
(2) The surviving spouse or surviving divorced spouse of a deceased
miner who meets the conditions of entitlement set forth in Sec.
725.212; or,
(3) Where neither exists, the child of a deceased miner who meets
the conditions of entitlement set forth in Sec. 725.218; or
(4) The surviving dependent parents, where there is no surviving
spouse or child, or the surviving dependent brothers or sisters, where
there is no surviving spouse, child, or parent, of a miner, who meet
the conditions of entitlement set forth in Sec. 725.222; or
(5) The child of a miner's surviving spouse who was receiving
benefits under Part C of the Act at the time of such spouse's death.
* * * * *
0
17. In Sec. 725.212, republish paragraph (a)(3) introductory text and
revise paragraphs (a)(3)(i) and (ii) to read as follows:
Sec. 725.212 Conditions of entitlement; surviving spouse or surviving
divorced spouse.
(a) * * *
(3) The deceased miner either:
(i) Is determined to have died due to pneumoconiosis; or
(ii) Filed a claim for benefits on or after January 1, 1982, which
results or resulted in a final award of benefits, and the surviving
spouse or surviving divorced spouse filed a claim for benefits after
January 1, 2005 which was pending on or after March 23, 2010.
* * * * *
0
18. In Sec. 725.218, republish paragraph (a) introductory text and
revise
[[Page 59118]]
paragraphs (a)(1) and (2) to read as follows:
Sec. 725.218 Conditions of entitlement; child.
(a) An individual is entitled to benefits where he or she meets the
required standards of relationship and dependency under this subpart
(see Sec. 725.220 and Sec. 725.221) and is the child of a deceased
miner who:
(1) Is determined to have died due to pneumoconiosis; or
(2) Filed a claim for benefits on or after January 1, 1982, which
results or resulted in a final award of benefits, and the surviving
child filed a claim for benefits after January 1, 2005 which was
pending on or after March 23, 2010.
* * * * *
0
19. In Sec. 725.222, republish paragraph (a)(5) introductory text and
revise paragraphs (a)(5)(i) and (ii) to read as follows:
Sec. 725.222 Conditions of entitlement; parent, brother or sister.
(a) * * *
(5) The deceased miner:
(i) Is determined to have died due to pneumoconiosis; or
(ii) Filed a claim for benefits on or after January 1, 1982, which
results or resulted in a final award of benefits, and the surviving
parent, brother or sister filed a claim for benefits after January 1,
2005 which was pending on or after March 23, 2010.
* * * * *
0
20. Revise Sec. 725.309 to read as follows:
Sec. 725.309 Additional claims; effect of prior denial of benefits.
(a) If a claimant files a claim under this part while another claim
filed by the claimant under this part is still pending, the later claim
must be merged with the earlier claim for all purposes. For purposes of
this section, a claim must be considered pending if it has not yet been
finally denied.
(b) If a claimant files a claim under this part within one year
after the effective date of a final order denying a claim previously
filed by the claimant under this part (see Sec. 725.502(a)(2)), the
later claim must be considered a request for modification of the prior
denial and will be processed and adjudicated under Sec. 725.310.
(c) If a claimant files a claim under this part more than one year
after the effective date of a final order denying a claim previously
filed by the claimant under this part (see Sec. 725.502(a)(2)), the
later claim must be considered a subsequent claim for benefits. A
subsequent claim will be processed and adjudicated in accordance with
the provisions of subparts E and F of this part. Except as provided in
paragraph (1) below, a subsequent claim must be denied unless the
claimant demonstrates that one of the applicable conditions of
entitlement (see Sec. Sec. 725.202(d) (miner), 725.212 (spouse),
725.218 (child), and 725.222 (parent, brother, or sister)) has changed
since the date upon which the order denying the prior claim became
final. The applicability of this paragraph may be waived by the
operator or fund, as appropriate. The following additional rules apply
to the adjudication of a subsequent claim:
(1) The requirement to establish a change in an applicable
condition of entitlement does not apply to a survivor's claim if the
requirements of Sec. Sec. 725.212(a)(3)(ii), 725.218(a)(2), or
725.222(a)(5)(ii) are met, and the survivor's prior claim was filed--
(i) On or before January 1, 2005, or
(ii) After January 1, 2005 and was finally denied prior to March
23, 2010.
(2) Any evidence submitted in connection with any prior claim must
be made a part of the record in the subsequent claim, provided that it
was not excluded in the adjudication of the prior claim.
(3) For purposes of this section, the applicable conditions of
entitlement are limited to those conditions upon which the prior denial
was based. For example, if the claim was denied solely on the basis
that the individual was not a miner, the subsequent claim must be
denied unless the individual worked as a miner following the prior
denial. Similarly, if the claim was denied because the miner did not
meet one or more of the eligibility criteria contained in part 718 of
this subchapter, the subsequent claim must be denied unless the miner
meets at least one of the criteria that he or she did not meet
previously.
(4) If the applicable condition(s) of entitlement relate to the
miner's physical condition, the subsequent claim may be approved only
if new evidence submitted in connection with the subsequent claim
establishes at least one applicable condition of entitlement. A
subsequent claim filed by a surviving spouse, child, parent, brother,
or sister must be denied unless the applicable conditions of
entitlement in such claim include at least one condition unrelated to
the miner's physical condition at the time of his death.
(5) If the claimant demonstrates a change in one of the applicable
conditions of entitlement, no findings made in connection with the
prior claim, except those based on a party's failure to contest an
issue (see Sec. 725.463), will be binding on any party in the
adjudication of the subsequent claim. However, any stipulation made by
any party in connection with the prior claim will be binding on that
party in the adjudication of the subsequent claim.
(6) In any case in which a subsequent claim is awarded, no benefits
may be paid for any period prior to the date upon which the order
denying the prior claim became final.
(d) In any case involving more than one claim filed by the same
claimant, under no circumstances are duplicate benefits payable for
concurrent periods of eligibility. Any duplicate benefits paid will be
subject to collection or offset under subpart H of this part.
0
21. Revise Sec. 725.418 to read as follows:
Sec. 725.418 Proposed decision and order.
(a) Within 20 days after the termination of all informal conference
proceedings, or, if no informal conference is held, at the conclusion
of the period permitted by Sec. 725.410(b) for the submission of
evidence, the district director will issue a proposed decision and
order. A proposed decision and order is a document, issued by the
district director after the evidentiary development of the claim is
completed and all contested issues, if any, are joined, which purports
to resolve a claim on the basis of the evidence submitted to or
obtained by the district director. A proposed decision and order will
be considered a final adjudication of a claim only as provided in Sec.
725.419. A proposed decision and order may be issued by the district
director at any time during the adjudication of any claim if:
(1) Issuance is authorized or required by this part;
(2) The district director determines that its issuance will
expedite the adjudication of the claim; or
(3) The district director determines that the claimant is a
survivor who is entitled to benefits under 30 U.S.C. 932(l). In such
cases, the district director may designate the responsible operator in
the proposed decision and order regardless of whether the requirements
of paragraph (d) of this section have been met. Any operator identified
as liable for benefits under this paragraph may challenge the finding
of liability by timely requesting revision of the proposed decision and
order and specifically indicating disagreement with that finding. See
20 CFR 725.419(a) and (b). In such cases, the district director must
allow all parties 30 days within which to submit liability evidence. At
the end of this
[[Page 59119]]
period, the district director must issue a new proposed decision and
order.
(b) A proposed decision and order must contain findings of fact and
conclusions of law. It must be served on all parties to the claim by
certified mail.
(c) The proposed decision and order must contain a notice of the
right of any interested party to request a formal hearing before the
Office of Administrative Law Judges. If the proposed decision and order
is a denial of benefits, and the claimant has previously filed a
request for a hearing, the proposed decision and order must notify the
claimant that the case will be referred for a hearing pursuant to the
previous request unless the claimant notifies the district director
that he no longer desires a hearing. If the proposed decision and order
is an award of benefits, and the designated responsible operator has
previously filed a request for a hearing, the proposed decision and
order must notify the operator that the case will be referred for a
hearing pursuant to the previous request unless the operator notifies
the district director that it no longer desires a hearing.
(d) The proposed decision and order must reflect the district
director's final designation of the responsible operator liable for the
payment of benefits. Except as provided in paragraph (a)(3) of this
section, no operator may be finally designated as the responsible
operator unless it has received notification of its potential liability
pursuant to Sec. 725.407, and the opportunity to submit additional
evidence pursuant to Sec. 725.410. The district director must dismiss,
as parties to the claim, all other potentially liable operators that
received notification pursuant to Sec. 725.407 and that were not
previously dismissed pursuant to Sec. 725.410(a)(3).
Signed at Washington, DC, this 16th day of September, 2013.
Gary A. Steinberg,
Acting Director, Office of Workers' Compensation Programs.
[FR Doc. 2013-22874 Filed 9-24-13; 8:45 am]
BILLING CODE 4510-CK-P